Integrating Primary Care Practices And Community-based .

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Integrating Primary Care Practices and Community-basedResources to Manage ObesityA Bridge-building Toolkit for Rural Primary Care PracticesPrepared forAgency for Healthcare Research and Quality540 Gaither RoadRockville, MD 20850www.ahrq.govContract No: HHSA290 2007 10016i 4, Task Order #21Grant No. UL1 RR024140 01 to Oregon Clinical and Translational Research Institute, from the NationalCenter for Research Resources, a component of the National Institutes of Health (NIH), and NIHRoadmap for Medical ResearchPrepared byPaul McGinnis, M.P.A., Oregon Rural Practice-based Research Network, Oregon Health & ScienceUniversityMelinda M. Davis, Ph.D., Oregon Rural Practice-based Research Network (ORPRN); Department ofFamily Medicine, Oregon Health & Science UniversitySonya Howk, M.P.A.:H.A., Oregon Rural Practice-based Research Network, Oregon Health & ScienceUniversityMolly DeSordi, B.A., Oregon Rural Practice-based Research Network, Oregon Health & ScienceUniversityMichelle Thomas, M.S.W., Oregon Rural Practice-based Research Network, Oregon Health & ScienceUniversityAHRQ Pub. N0. 14-0043-EFMay 2014

AcknowledgementsThe authors would like to thank the following experts for their contributions and comments on thistoolkit: Lyle J. Fagnan, M.D., Network Director, Oregon Rural Practice-based Research Network;Professor, Department of Family Medicine, Oregon Health & Science University, Portland, OR Kristin Dillon, M.D., Columbia Gorge Family Medicine, Hood River, OR Francie Karr, Clinic Administrator, Columbia Gorge Family Medicine, Hood River, OR Lorena Sprager, Outreach Coordinator, Nuestra Comunidad Sana, The Next Door, Inc., HoodRiver, OR Maria Antonia Sánchez, Lead Health Promoter, Nuestra Comunidad Sana, Hood River, OR Donna Daniels, Ph.D., Director of Technical Assistance for the Safety Net Medical HomeInitiative, Qualis Health, Seattle, Washington Tom Eversol, D.V.M., M.S., Director of Strategic Development for College of Public Health andHuman Sciences, Oregon State University, Corvallis, OR Troy Soenen, M.B.A., Director of Field Services, Oregon Office of Rural Health, Oregon Health &Science University Portland, OR Danna D. Hastings, M.Div., Chronic Disease Programs Manager, Health Promotion and ChronicDisease Prevention Section, Oregon Public Health Services, Oregon Health Authority, Salem, OR Kerry Gonzalez, Executive Director, Oregon Academy of Family Physicians, Portland, OR Iris Mabry-Hernandez, M.D., M.P.H., Project Officer for Pediatric Research Grants andContracts, Agency for Healthcare Research and Quality, Rockville, MD The clinicians and staff at the following primary care clinics:o Bayshore Family Medicine, Lincoln City, ORo Lincoln City Medical Center, Lincoln City, ORo Madras Medical Group, Madras, ORo Mosaic Medical – Madras, Madras, ORo Mosaic Medial – Prineville, Prineville, ORo M/More Care, Prineville, ORo Columbia Gorge Family Medicine, Hood River, ORo La Clinica del Carino, Hood River, OR The following coordinator and community members and their associated communitycoalitions:o Julia Young-Lorion, M.P.H., and the Lincoln County Community Health ImprovementPartnership, Newport, ORo Sharon Vail and the Jefferson County Community Health Improvement Partnership,Prineville, ORo Beth Ann Beamer, B.S.N., R.N., and the Mountain View Community HealthImprovement and Research Partnership, Madras, ORo Lorena Sprager and associates, The Next Door, Inc., Hood River, ORii

SupportThis work was made possible through the support of the Agency for Healthcare Research and Qualityunder master contract task order #21 (HHSA290 2007 10016i 4) and the Oregon Clinical andTranslational Research Institute, grant number UL1 RR024140 01 from the National Center forResearch Resources, a component of the National Institutes of Health (NIH), and NIH Roadmap forMedical Research.Study data were managed using REDCap electronic data capture tools hosted at Oregon Health &Science University.1 REDCap (Research Electronic Dat

1. Evaluate local clinic and community factors necessary to develop sustainable linkages between primary care and community resources for obesity management, and 2. Design, implement, and evaluate a participatory process using practice facilit ation and community-health development principles to achieve these linkages .

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