摘要：Objectives. We conducted a literature review and environmental scan to develop a framework for interventions that utilize linkages between clinical practices and community organizations for the delivery of preventive services, and to identify and characterize these efforts. Methods. We searched 4 major health services and social science electronic databases and conducted an Internet search to identify examples of linkage interventions in the areas of tobacco cessation, obesity, nutrition, and physical activity. Results. We identified 49 interventions, of which 18 examples described their evaluation methods or reported any intervention outcomes. Few conducted evaluations that were rigorous enough to capture changes in intermediate or long-term health outcomes. Outcomes in these evaluations were primarily patient-focused and did not include organizational or linkage characteristics. Conclusions. An attractive option to increase the delivery of preventive services is to link primary care practices to community organizations; evidence is not yet conclusive, however, that such linkage interventions are effective. Findings provide recommendations to researchers and organizations that fund research, and call for a framework and metrics to study linkage interventions. The US health care delivery system plays a critical role in helping patients address unhealthy behaviors, such as tobacco use, unhealthy diet, and physical inactivity, which are the leading causes of preventable morbidity and mortality in the United States. 1,2 The US Preventive Services Task Force provides specific recommendations for the delivery of clinical preventive services, such as screening, behavioral counseling, and referral to behavioral change programs, to support patients in behavior change and decrease their risk for chronic disease and death. 3–6 Despite these recommendations, patients are not receiving the appropriate clinical preventive services in their doctors’ offices. A large national study reported that patients receive only about half of the recommended clinical preventive services overall and less than 20% of recommended counseling or education services. 7 The alternative to delivering preventive services such as counseling in a clinical setting is to provide referrals to outside providers, such as local health departments, tobacco quitlines, or community-based organizations. However, available evidence suggests that this practice is also not common. 8 This may be a result of limited and variable access to such services. 9,10 Even when available, services may be underutilized because clinicians are unaware of the resources or because they face numerous barriers related to reimbursement, organizational structure, and interorganizational linkages. 11,12 Although recent studies have suggested that linkages between organizations for referrals may be facilitated by advanced communication technologies, 13 these changes may be difficult for the average practice to implement. In general, little is known about these linkage interventions and whether they represent an effective and efficient mechanism for delivery of preventive services. To advance the field of studying linkage interventions between clinical practices and public health or community organizations, a better understanding of the types of outcomes that have been studied, a framework for choosing relevant outcomes, and an understanding of the evidence to date for linkage interventions are needed. In 2009 and 2010, under contract from the Agency for Healthcare Research and Quality (AHRQ), RTI International conducted a literature review and environmental scan to identify examples of linkages between clinical practices and community organizations and to characterize these efforts. 14 We summarize findings from the literature review and environmental scan that specifically addressed the following evaluation questions: What outcomes were measured? What data sources and methods were used? What were the results of evaluations of the interventions?
