Integrating Chronic Disease and Risk Factor Programs in a State Public Health Department: Colorado's Vision, Implementation and Lessons Learned

In 2008, Colorado was selected as one of four states to participate in CDC's chronic disease integration demonstration project. Colorado's integration effort focuses on improved effectiveness and efficiency in reaching long-term health outcomes. Over two years, managers of the state's chronic disease and risk factor programs have engaged in a collective planning and decision-making process that resulted in a single integrated workplan to replace the categorical work plans of nine different programs. Collective decisions were based on data, public health role, evidence base for interventions and feasibility. A centralized team of evaluators and epidemiologists facilitated and advised the planning process. Business practices have been streamlined to support integrated work. Program and staffing structures have been changed to better align with the integrated workplan and to provide the flexibility that makes best use of staff strengths and skills. The process of organizational change brings significant challenges, including overcoming organizational inertia, fear of change, bureaucratic roadblocks and steep learning curves. It is important that managers have courage and vision, staff members are flexible and invested in the process, and leaders support a collaborative process that fosters an organizational commitment to change. Colorado's experience suggests the promise of an integrated approach while acknowledging the difficulties inherent in organizational change. Integration enables Colorado's health department to align programs and allocate resources to best help local health partners, community based organizations and citizens prevent and manage chronic disease.