Which statement best describes the Midstream level in the care delivery model?

• A. Addressing immediate, local barriers within communities
• B. Focusing on long-term policy changes
• C. Providing only direct patient care
• D. Ignoring social determinants

Answer: (A)

Midstream work focuses on practical actions at the community and health-system level to remove immediate barriers people face when accessing care. It sits between high-level policy changes (upstream) and what happens in the clinic with individual patients (downstream). By addressing local obstacles—like transportation to appointments, inconvenient clinic hours, language or cultural barriers, and linking people to community resources—midstream connects people to care and helps services reach neighborhoods with the greatest need. That’s why the statement about addressing immediate, local barriers within communities best describes this level. Focusing on long-term policy changes is upstream, providing only direct patient care is downstream, and ignoring social determinants would miss the core aim of midstream work, which is to intervene on the community and systemic factors that shape access to care.