Million Hearts® Special Features

American Heart Association Million Hearts® Collaboration
Community-Clinical Linkages Toolkit 2018


The American Heart Association and the Million Hearts® Collaboration developed the Million Hearts® Community-Clinical Linkages Toolkit to complement the Centers for Disease Control and Prevention's Practitioner’s Guide: Community-Clinical Linkages for the Prevention and Control of Chronic Diseases.

Heart disease, stroke and other cardiovascular diseases kill more than 800,000 Americans each year, accounting for one in every three deaths. Cardiovascular disease is the nation’s number one killer among both men and women and the leading cause of health disparities across the population. To address this issue, the U.S. Department of Health and Human Services (HHS) established Million Hearts®, an initiative co-led by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) that aims to prevent one million heart attacks, strokes or other cardiovascular events in five years.

The Million Hearts® Initiative coordinates and enhances cardiovascular disease prevention activities across public and private sectors and has been successful in developing tools for many partners. Public health departments play a critical role in addressing cardiovascular health needs by collaborating with community partners and advancing the Million Hearts® mission. Million Hearts® has brought together existing efforts and new programs to improve health across communities through innovative collaboration between public health, primary care, community clinics and community-centered organizations. This collaboration will continue to scale up proven clinical and community strategies to prevent heart attacks and strokes across the nation.

For more information about Million Hearts® and the resources that have been developed by the CDC Million Hearts® team, visit their webpage:

Definition of Community-Clinical Linkages

Community-Clinical Linkages (CCL) are defined as connections between community and clinical sectors to improve population health. As noted in the Community-Clinical Linkages Practitioner’s Guide, community-clinical linkages are an effective approach to prevent and control chronic diseases. Research has shown Community-Clinical Linkages improve clinical outcomes in heart disease, blood pressure, cholesterol, diabetes and asthma. Community-Clinical Linkages also improve behavioral changes in nutrition, physical activity, diabetes self-management, smoking cessation and medication adherence.

The Community-Clinical Linkages Practitioner’s Guide presents strategies that involve practitioners from the public health sector who are leading efforts to link community and clinical sectors (see Figure 1).


Purpose and Goals of the Community-Clinical Linkages Toolkit

Key partners of the Million Hearts® initiative are public health departments—they play a critical role in addressing cardiovascular health needs through collaboration with community partners. The Community Clinical-Linkages Toolkit adds to the collection of Million Hearts® tools and is intended to help public health practitioners further the Million Hearts® goal of preventing heart attacks and strokes through the development and strengthening of effective community-clinical linkages.

Building on the experience, expertise, and partnership of the first five years, Million Hearts® 2022 seeks strong and specific commitments to the priorities so that together we can improve cardiovascular health for all. Public health departments are well-positioned to lead the charge to bring together community and clinical stakeholders in collaborative effort to positively impact cardiovascular health.

How Public Health Practitioners Can/Should Use the Community-Clinical Linkages toolkit

The Community-Clinical Linkages Toolkit has been developed to help public health practitioners implement the following seven step-by-step LINKAGES strategies that are highlighted in the Community-Clinical Linkages Practitioner’s Guide’s LINKAGE framework:
  • Learn about community and clinical sectors.
  • Identify and engage key stakeholders from community and clinical sectors.
  • Negotiate and agree on goals and objectives of the linkage.
  • Know which operational structure to implement.
  • Aim to coordinate and manage the linkage.
  • Grow the linkage with sustainability in mind.
  • Evaluate the linkage.

For each of these seven LINKAGE strategies, the Community-Clinical Linkages Toolkit provides resources that were obtained from state- and local-level organizations to help implement each strategy. The resources have links and brief descriptions of their contents. Wherever possible, the originating agency’s description of the entry has been used.

The user will find resource lists, white papers, case studies, examples of referral forms and clinic check-off lists. Strategies that demonstrate how to incorporate community health workers, community pharmacy programs, primary care and community outreach are also included. Additional resources address the use of electronic health records (EHR) and data to identify areas of need and activate funding sources.


Million Hearts® Collaboration Community-Clinical Linkages Workgroup:

  • American Heart Association (AHA)
  • Association of Public Health Nurses (APHN)
  • Association of State and Territorial Health Officials (ASTHO)
  • Centers for Disease Control and Prevention (CDC)
  • National Association of Chronic Disease Directors (NACDD)
  • National Association of County and City Health Officials (NACCHO)
  • National Forum for Heart Disease and Stroke Prevention
  • The Ohio State University (OSU)
  • Preventive Cardiovascular Nurses Association (PCNA)