Healthcare, prevention, and the promotion and facilitation of healthy behaviors are not limited to healthcare institutions. Primary care can more effectively provide comprehensive, whole-person healthcare by working with the communities in which they are located, including developing partnerships with schools, workplaces, and community-based organizations and services. Community health workers—the community members that work with a health clinic—often help to build and maintain these clinical-community partnerships.35 While medical care focuses on supporting patients’ individual health needs, public health focuses on the prevention and control of infectious and chronic diseases for an entire population.36 Public health agencies support primary care through disease surveillance, emergency preparedness and response, and community-wide promotion of physical and mental health efforts. Close collaboration between public health and primary care can help to save resources, improve individual patient outcomes, and improve population health outcomes.37
In this section, we describe AHRQ primary care research grants focused on developing linkages between primary care and the community, including public health organizations.
Grants
Across the AHRQ primary care research grants with active funding in FYs 2023 and 2024, three grants focus on public health and community integration. This includes one R01 (Research Projects), one R18 (Research Demonstration and Dissemination Project), and one K08 (Mentored Clinical Scientist Development Award).
There are an additional 6 grants with some focus on Public Health and Community Integration, which are described in other topic area sections, including one in Healthcare Systems and Infrastructure, one in Practice and Quality Improvement, one in Healthcare Disparities, one in Behavioral Health and Substance Use Disorders, one in Digital Healthcare, and one in Person-Centered Care.
We summarize the three grants focused on public health and community integration below.
(R18)
PI: Meghan McHugh
Organization: Northwestern University at Chicago
Grant Start Date: September 1, 2023
Examines the effectiveness of worksite health clinics providing hypertension control and smoking cessation interventions to improve cardiovascular care in manufacturing communities. Evidence-based interventions are drawn from AHRQ’s EvidenceNOW model, a blueprint for delivering external support to primary care practices to improve primary care delivery. Measurements collected include facilitators and barriers to sustainability, the effectiveness of the interventions, and budget implications.
(R01)
PI: Sharon Hewner
Organization: State University of New York at Buffalo
Grant Start Date: April 1, 2021
Tests a personalized, cross-sector, transitional care management model in primary care and behavioral health settings to improve care coordination across settings using a health information exchange infrastructure for high-need/high-cost patients or patients with multiple chronic conditions, functional disabilities, and/or social needs. 
Learn more about this study in a Primary Care Research Profile: Supporting Patients with Complex Medical and Social Needs During Transitions in Care (PDF, 277 KB).
(K08)
PI: Jamie Peterson
Organization: Oregon Health & Science University
Grant Start Date: March 1, 2023
Develops and pilots a package of pediatric clinic-based school readiness interventions that are specifically designed to target the needs and desires of Latino families.
Initiatives and Resources
ÂÜÀòÊÓƵshares resources for clinical-community partnerships and SDOH resources for clinicians and researchers. There were no new public health and community integration initiatives or resources related to primary care released in FYs 2023 and 2024.
