Coalitions: A Promising Coalitions: A Promising Way to Enhance Asthma Way to Enhance Asthma

Control Control

Noreen M. Clark, Ph.D. Noreen M. Clark, Ph.D.

School of Public Health School of Public Health

University of MichiganUniversity of Michigan

Patient Self-Patient Self-ManagementManagement

Family InvolvementFamily Involvement

Clinical ExpertiseClinical Expertise

Work/School SupportWork/School Support

Community Awareness & ActionCommunity Awareness & Action

Environmental MeasuresEnvironmental Measures

Conducive PoliciesConducive Policies

Some Assumptions about Some Assumptions about Effective Asthma Coalitions:Effective Asthma Coalitions:

integrate expertise of health integrate expertise of health professionals, patients, and lay professionals, patients, and lay personspersons

derive momentum from derive momentum from community interest and concerncommunity interest and concern

coordinate asthma - directed coordinate asthma - directed initiativesinitiatives

Some Assumptions about Some Assumptions about Effective Asthma Coalitions:Effective Asthma Coalitions:

produce intermediate outcomes produce intermediate outcomes (e.g. across institutions/sectors, (e.g. across institutions/sectors, management skills, referral management skills, referral systems)systems)

intermediate outcomes contribute intermediate outcomes contribute to alternate desired health to alternate desired health outcomes (e.g. patient health outcomes (e.g. patient health status, health care use)status, health care use)

OutputsOutputs

more anti-more anti-inflamm. useinflamm. use

patient action patient action plans providedplans provided

increased patient increased patient self mgmt.self mgmt.

availability of availability of reimbursementreimbursement

more continuity more continuity of careof care

surveillance surveillance systemssystems

using meds at using meds at schoolschool

etc.etc.

Health Related Health Related Outcomes Outcomes

fewer fewer symptomssymptoms

less health care less health care useuse

better quality of better quality of lifelife

improved improved school school attendanceattendance

etc.etc.

Coalition Coalition ProcessesProcesses

membershipmembership leadershipleadership participationparticipation relationshipsrelationships etc.etc.

Coalition Coalition

InputInput

clinician clinician educationeducation

patient patient educationeducation

redesign of redesign of servicesservices

educate educate payors/ payors/ fiduciaries fiduciaries

policy policy initiativesinitiatives

etc.etc.

Existing research (see e.g. Existing research (see e.g. Wickizer (1998), Kenney and Wickizer (1998), Kenney and Sofaer (2000), Laurett et. al Sofaer (2000), Laurett et. al (1997), Mayer et al (1997), (1997), Mayer et al (1997), Buftterfosset et al (1993) Buftterfosset et al (1993) describes coalitions structures describes coalitions structures and provides tools for assessing and provides tools for assessing coalition processes and coalition processes and functioning.functioning.

Few data are available to describe intermediate or final health related outcomes associated with coalition efforts

Need here INFORE: Fresno, Chicago, St.

Louis any others? Susan I will get to you

NHLBI and RWJF Collaboration to Explore Coalitions

NHLBI - support and assistance to 8 coalitions

RWJF: Allies Against Asthma - funding and technical assistance to 8 coalitions

Jointly: Coalition meetings, shared information, coordinated assistance, etc.

Allies Against AsthmaAllies Against Asthma

National Advisory Committee - MembersMichele CarrickParent and family advocate

Barbara Israel, Ph.D.(community participatory research)Professor, University of MichiganSchool of Public Health

Guy Parcel, Ph.D.(School Health) Professor,University of Texas School ofPublic Health

Mary desVignes-Kendrick, M.D.,M.P.H.Director, City of Houston Health Department

Talmadge King, M.D.(Pulmonologist) Professor,University of California at SanFrancisco

Stephen Redd, M.D.Chief, Air Pollution and RespiratoryHealth Branch, Centers for DiseaseControl and Prevention

Susan Downey, M.Ed.(former director of communitycoalition) Community PreventionSpecialist, Boston, MA

Floyd Malveaux, M.D.(Allergist)Dean, Howard UniversityCollege of Medicine

Jeanne Taylor, Ph.D.Director, Ambulatory Care andCommunity Health ServicesUniversity of Chicago

Robinson (Rob) Fulwood,M.S.P.H.Senior Manager, National Heart,Lung and Blood Institute

Robert Mellins, M.D.(Pediatric Pulmonologist)Professor, Columbia UniversitySchool of Medicine

Abe Wandersman, Ph.D.(evaluation of coalitions) Professor,University of South Carolina

Rachel A. Gonzales-HansonCEO, Uvalde County Clinic,Community Health CenterUvalde, TX

Stephen Page, M.P.A.Director, Radiation and Indoor AirEnvironmental Protection Agency

Sandra Wilson, Ph.D.(self management expert)Senior Staff ScientistStanford Lung Disease Center

Physician Asthma Care Physician Asthma Care Education (PACE)Education (PACE)

RWJF funded exploration of RWJF funded exploration of two pronged dissemination two pronged dissemination (national/local) of an NHLBI (national/local) of an NHLBI funded model for clinician funded model for clinician training. Potential clinical training. Potential clinical education component for education component for coalitions.coalitions.

Coalitions hold promise for Coalitions hold promise for contributing to asthma contributing to asthma control but questions control but questions remain that require careful remain that require careful study.study.

Research questions:

Are coalition activities associated with desired health outcomes?

In what ways do coalitions produce results different/better than other types of intervention?

What characterizes a successful coalition?

Research questions:

What elements of coalition activity are most effective?

How can coalition effectiveness be enhanced?

How can coalition efforts be institutionalized?