The environmental scan focused on identifying previous work that may be relevant to measuring the structures and processes surrounding effective clinical-community relationships for prevention. A resource was deemed relevant if it highlighted some form of relationship between a clinical and community resource and evaluated the relationship in some manner. Beyond surveying published peer-reviewed articles, unpublished literature such as dissertations, white papers, and other forms of publicly available information were included in the search. The environmental scan was performed in two phases—a literature review and a Web search. The scan did not evaluate identified resources for the quality of methods used or research rigor.
For the literature review, iterative database searches were conducted. Various combinations of terms were searched and citation titles and abstracts were scanned to determine if the content related to measures of clinical-community relationships. As part of the search strategy, the following search parameters and terms were employed to facilitate the scanning of databases:
Search Parameters. The following parameters for database searches of published literature were employed:
- English language.
- 2000 – present.
- United States and international.
- Exclusion of editorials, commentaries, and book reviews.
Search Terms. A list of keywords was generated and then grouped into four categories:
- Terms relating to community resources.
- Terms dealing with clinical practices.
- Terms describing relationships; and.
- Terms related to measures.
Table C-1 contains a complete list of search terms used for both the literature review and the Web search.
Table C-1. Search terms for literature review and Web search
|Community organizations/ services/resources||Primary clinical practices||Relationships||Measurement|
|Community Health||Medical Home||Relationships||Measure|
|Clinical Preventive Services||Clinic||Partnerships||Performance|
|Practice-Based Public Health||Pediatrics||Collaborations||Performance Results|
|Community Wellness||Primary Care||Networks||Survey/Surveillance|
|Directive Counseling||Family Practice||Coordination||Assessment|
|Community-Based Participatory Research (CBPR)||Primary Physician||Systems||Analysis|
|Patient Education||Primary Medicine||Referrals||Effectiveness|
|Community Resources||Care Coordination|
To operationalize the search, Boolean operators (i.e., AND, OR) between each of the keywords and their categories were used. Within an article, the goal was to find at least one of the terms within the column; thus, using "OR" between all of the terms within a column. There was also an interest in the combination of terms across columns, therefore the "AND" term was used for terms across columns. For example, a search incorporating both concepts of measurement and relationships would proceed as follows: ("effectiveness" OR "metric" OR "measurement" OR "evaluation") AND ("referrals" OR "sharing" OR "system" OR "linkage"). Further, variants of the search terms were included; for example, "medical home" and "medical homes." Along with the four categories mentioned, exact phrases were searched, including "clinical community relationships," "clinical community linkages," and "clinical community partnerships."
Experts were also identified in the field of clinical-community relationships and a search of publications since 2007 was conducted; these experts are listed in Table C-2.
Table C-2. Experts identified for author search
|Melinda K. Abrams, MS||Russell E. Glasgow, PhD|
|Richard C. Antonelli, MD, MS, FAAP||Lawrence W. Green, DrPH|
|Cheryl B. Aspy, MEd, PhD||Charles J. Homer, MD, MPH|
|Stephanie B. Bailey, MD, MSHSA||David Labby, MD, PhD|
|Leslie M. Beitsch, MD, JD||Therese Miller, DrPH|
|Peter Beilenson, MD||Amy Schultz, MD, MPH|
|Allen D. Cheadle, PhD||Ruta K. Valaitis, RN, PhD|
|Rebecca S. Etz, PhD||Claire Weschler, MSEd, CHES|
|Janice L. Genevro, PhD|
Using the search terms from Table C-1 and the parameters mentioned above, the following electronic databases were scanned:
- Applied Social Sciences Index and Abstracts (ASSIA). Covers health, social services, psychology, sociology, economics, politics, race relations, and education literature.
- FirstSearch. A Web-based online information service that provides access to bibliographic and full-text databases in all subject disciplines.
- Health and Psychosocial Instruments (HAPI). Provides information on measurement instruments (i.e., questionnaires, rating scales, tests, index measures, coding schemes, checklists) in the fields of public health and medicine, psychosocial sciences, communication, organizational behavior, and others. HAPI records do not contain the actual instruments, but often direct the researcher to sources of measures needed for research, assessment, and evaluation.
- PsycINFO. Covers international literature in the psychological, psychiatric, social, behavioral, and health sciences.
- PUBMED. Covers all aspects of health and medical literature.
For the Web search, using similar search queries to those for the database, the first 20 links were reviewed for possible clinical-community relationships. Further, the Web sites highlighted in Table C-3 were reviewed.
Table C-3. Targeted organization Web sites
|National Quality Measures Clearinghouse™ (NQMC)|
|National Quality Forum (NQF)|
|Continuous Enhancement of Quality Measurement (CEQM)|
|National Committee for Quality Assurance (NCQA)|
|Physician Consortium for Performance Improvement (PCPI)|
|Agency for Healthcare Research and Quality (AHRQ)|
|Centers for Disease Control and Prevention (CDC)|
|Community Preventive Services Task Force|
|Health Resources and Services Administration (HRSA)|
|Public and Private Organizations|
|Robert Wood Johnson Foundation (RWJF)|
|W.K. Kellogg Foundation (WKKF)|
|Kaiser Family Foundation (KFF)|
|Practitioner and Public Health-Related Organizations|
|American Medical Association (AMA)|
|American Academy of Family Physicians (AAFP)|
|American Public Health Association (APHA)|
|American College of Preventive Medicine (ACPM)|
|American Academy of Pediatrics (PPC)|
|Other Prevention Partnerships|
|Association of Prevention Teaching and Research (APTR)|
|Association of State and Territorial Health Officials (ASTHO)|
|National Association of County and City Health Officials (NACCHO)|
The following specific inclusion/exclusion criteria were used to select relevant resources for further review:
- Must contain a linkage or relationship between a clinical setting (internal medicine, pediatrics, family practice, OB/GYN) and a community health organization.
- Must contain a description of a measurement or an evaluation of the linkage/relationship between the clinical setting and the community health organization.
- Should not only report on the evaluation of the health outcomes of patients/participants (e.g., changes in body mass index [BMI], weight loss, quit cessation rates, etc.)—those that did were not included in the list of relevant articles.
Once resources were identified, a review team determined whether the selected articles or Web Sites contained measures of the structures and processes surrounding effective clinical-community relationships for prevention. In order to determine this, the articles were analyzed for the following information:
- Clinical Setting. What clinical setting participated in the relationship? The clinical setting must focus on primary care.
- Prevention. What prevention strategy is the relationship addressing? Specifically, which U.S. Preventive Services Task Force recommendation(s)?.
- Community Setting. What nonclinical community resource/entity participated in the relationship?.
- Nature of Relationship. Is there a formal relationship between/among the clinical setting and community? Are resources shared? What processes fostered the relationship?.
- Denominator. Specifies which members of the eligible population are to be counted in the denominator.
- Numerator. A count of the members of the denominator who achieved specified outcomes.
- Data Source(s). How are the data collected? This may include claims data, community assessments, or surveys.
A total of 534 unduplicated abstracts were reviewed and, ultimately, 9 articles describing 20 measures were included from the literature search. An additional 4 measures were found in the Internet search for a combined total of 24 measures. Initially, only articles describing a linkage or relationship between a primary care clinical setting and a nonclinical community organization were included. Articles that focused on mental health settings were ultimately included, however, but only when it was determined that measures from these articles could be adapted for primary care settings.