Online Program

CTG National Network: YMCA of the USA's Lessons Learned in Closing the Clinic-to-Community Gap

Tuesday, November 5, 2013 : 11:30 a.m. - 11:50 a.m.

Katherine Hohman, MPH, Healthy Living Department, YMCA of the USA, Washington, DC
Aleece Smith, YMCA of the USA, Chicago, IL
Shannon Cosgrove, MHA, Healthier Communities Initiative, YMCA of the USA, Washington, DC
YMCA of the USA and its 10 CTG sub-recipients changed systems by developing clinic-to-community linkages between health care providers and community-based organizations, expanding the reach of the YMCA's Diabetes Prevention Program into communities experiencing health disparities to reduce the incidence of type 2 diabetes. Y-USA's sub-recipients facilitated access to the YMCA's Diabetes Prevention Program by developing relationships with healthcare providers in focal communities. Sub-recipients and these providers completed the Y's Clinic-to-Community Assessment Tool to identify opportunities to strengthen clinic-to-community partnerships promoting chronic disease management and prevention to support those at risk of or living with chronic disease. The Clinic-to-Community Assessment drew upon the community-centric process of the Y's Community Healthy Living Index and expands on topics covered in the health care section of CDC's CHANGE. All sub-recipients completed a Clinic-to-Community Assessment within a year of initial funding. Of twenty-two assessments entered into an online system, 27% were community clinics, 23% were FQHCs, and 18% were private medical/physician offices. Providers were urban (73%), accepted public insurance (95%), and served low income (80%) and non-White (54%) patients. Twenty-seven percent (27%) indicated implementing policies to address the need for a chronic disease referral system to CBOs. Sub-recipients reported that the Clinic-to-Community Assessment was a first step in building relationships and bridging knowledge gaps between CBOs and providers, but underlying health care system factors limit referrals between providers and CBOs. Promising strategies tested by sub-recipients include adding specific pre-diabetes diagnoses, implementing referral prompts in EHRs, providing referral resources for patients, and addressing privacy issues.

Learning Areas:

Chronic disease management and prevention
Other professions or practice related to public health

Learning Objectives:
Describe the significance of developing clinic-to-community linkages between health care providers and community-based organizations in improving the health of communities. Understand system-level barriers that influence the ability to establish referral systems between health care providers and community based organizations. Identify promising practices for building clinic-to-community linkages and innovative strategies to overcome barriers in establishing referral systems.

Keyword(s): Clinical Prevention Services, Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: For the past four years I have been involved in the support and evaluation of YMCA of the USA's policy and environmental change work. This work has included PHC, ACHIEVE, CTG and REACH.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.