1. Piper, Crystal N. PhD, MPH, MHA
  2. Plescia, Marcus MD, MPH
  3. Keener, Stephen R. MD, MPH
  4. DeHaven, Mark PhD


Context: Better integration of public health and medical services has been a long-standing goal in the United States and has been widely discussed in the scientific literature.


Objective: To identify key lessons and outcomes of the Mecklenburg County Interlocal Agreement, one of the longest running efforts integrating health care delivery and public health services in a major metropolitan area.


Design: In-depth key informant interviews and brief questionnaires of leaders involved in the Mecklenburg County Interlocal Agreement.


Setting: Charlotte-Mecklenburg County, North Carolina.


Participants: Convenience sample of 15 past and present employees and administrative leaders of the Mecklenburg County Privatization Initiative from the Mecklenburg County Health Department (N = 7) and Carolinas Healthcare System (N = 8).


Main Outcome Measures: Attitudes reflecting the effects of the Mecklenburg County Privatization Initiative, based on 6 "synergies" for evaluating the effectiveness of health care and public health system collaboration.


Results: Mean scores were calculated for 21 questionnaire items, using 5-point Likert scales (1 = no impact; 5 = great impact). Mean scores were calculated by averaging the multiple-item question sets reflecting each of the 6 synergies. Synergy scores ranged from a low of 3.1 (3 items reflecting whether the collaboration "Used clinical practice to identify and address community health problems") to a high of 3.7 (3 items reflecting whether the collaboration "Improved health care by coordinating services for individuals"). The in-depth interviews indicated a clear impact for the 2 synergies linked to individual care. Increased access to care emerged as a strong theme, along with the belief that medical care services were improved and that these improvements persist.


Conclusion: The findings of this study provide perspective from an 18-year contractual agreement for a large health care system to operate county public health functions. Implications include the need to incorporate well-defined public health principles in any collaborative agreement and to focus these efforts at the primary care level.