ABSTRACT
INTRODUCTION: There is growing recognition of the important role that social and environmental conditions play in health, and of the interaction needed between clinical providers and the broader community in which patients live, work, play, and manage their health. Through the Safety Net Enhancement Initiative, the Kresge Foundation funded demonstration projects in eight vulnerable communities to address health inequities and increase integration between clinical and community systems. METHODS: In 2014, integration efforts in 2011-2013 were qualitatively analyzed within and between sites to identify common features. The series of steps taken by sites during the 3-year implementation period that were necessary to move toward integration were then analyzed. RESULTS: Safety Net Enhancement Initiative sites increased capacities within clinics, including policy and practice changes that expanded the way "health" is defined by clinical providers and the implementation of onsite programs/services. Several sites changed clinic policies to support referral to community programs with partner organizations. Several sites also successfully changed local community policies and practices. Moving toward integration, mechanisms were created to link newly developed or identified community resources to the clinical system. CONCLUSIONS: As an established system organized around disease treatment, not prevention, certain changes need to be made within the clinical system to prepare for integration. These changes require shifting perspectives, changing behaviors, and developing novel administrative models. Similarly, integration requires changes within and among community systems, including organizations, services, and residents. Ultimately, there is the need to find ways for these two very different environments to interact and coordinate.
