The Mecklenburg County Interlocal Agreement: An 18-Year Collaboration Between Medicine and Public Health.

Abstract

Better integration of public health and medical services has been a long-standing goal in the United States and has been widely discussed in the scientific literature. To identify key lessons and outcomes of the Mecklenburg County Interlocal Agreement, one of the longest running efforts integrating health care delivery and public health services in a major metropolitan area. In-depth key informant interviews and brief questionnaires of leaders involved in the Mecklenburg County Interlocal Agreement. Charlotte-Mecklenburg County, North Carolina. Convenience sample of 15 past and present employees and administrative leaders of the Mecklenburg County Privatization Initiative from the Mecklenburg County Health Department (N = 7) and Carolinas Healthcare System (N = 8). Attitudes reflecting the effects of the Mecklenburg County Privatization Initiative, based on 6 "synergies" for evaluating the effectiveness of health care and public health system collaboration. Mean scores were calculated for 21 questionnaire items, using 5-point Likert scales (1 = no impact; 5 = great impact). Mean scores were calculated by averaging the multiple-item question sets reflecting each of the 6 synergies. Synergy scores ranged from a low of 3.1 (3 items reflecting whether the collaboration "Used clinical practice to identify and address community health problems") to a high of 3.7 (3 items reflecting whether the collaboration "Improved health care by coordinating services for individuals"). The in-depth interviews indicated a clear impact for the 2 synergies linked to individual care. Increased access to care emerged as a strong theme, along with the belief that medical care services were improved and that these improvements persist. The findings of this study provide perspective from an 18-year contractual agreement for a large health care system to operate county public health functions. Implications include the need to incorporate well-defined public health principles in any collaborative agreement and to focus these efforts at the primary care level.