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Calancie L, Frerichs L, Davis MM, Sullivan E, White AM, Cilenti D, Corbie-Smith G, Hassmiller Lich K. Consolidated Framework for Collaboration Research derived from a systematic review of theories, models, frameworks and principles for cross-sector collaboration. PLoS One 2021; 16:e0244501. [PMID: 33395449 PMCID: PMC7781480 DOI: 10.1371/journal.pone.0244501] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/10/2020] [Indexed: 02/04/2023] Open
Abstract
Cross-sector collaboration is needed to address root causes of persistent public health challenges. We conducted a systematic literature review to identify studies describing theories, models, frameworks and principles for cross-sector collaboration and synthesized collaboration constructs into the Consolidated Framework for Collaboration Research (CFCR). Ninety-five articles were included in the review. Constructs were abstracted from articles and grouped into seven domains within the framework: community context; group composition; structure and internal processes; group dynamics; social capital; activities that influence or take place within the collaboration; activities that influence or take place within the broader community; and activities that influence or take place both in the collaboration and in the community. Community engagement strategies employed by collaborations are discussed, as well as recommendations for using systems science methods for testing specific mechanisms of how constructs identified in the review influence one another. Researchers, funders, and collaboration members can use the consolidated framework to articulate components of collaboration and test mechanisms explaining how collaborations function. By working from a consolidated framework of collaboration terms and using systems science methods, researchers can advance evidence for the efficacy of cross-sector collaborations.
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Affiliation(s)
- Larissa Calancie
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
- * E-mail:
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Melinda M. Davis
- Oregon Rural Practice-based Research Network, School of Medicine, Oregon Health and Science University, Portland, OR, United States of America
| | - Eliana Sullivan
- Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland, OR, United States of America
| | - Ann Marie White
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Dorothy Cilenti
- Department of Maternal and Child Health, National Maternal and Child Health Workforce Development Center, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Giselle Corbie-Smith
- Departments of Social Medicine and Internal Medicine, UNC Center for Health Equity Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Willgerodt M, Johnson KH, Helmer C. Enhancing Care Coordination for Students with Type 1 Diabetes. THE JOURNAL OF SCHOOL HEALTH 2020; 90:651-657. [PMID: 32557632 DOI: 10.1111/josh.12912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 11/13/2019] [Accepted: 01/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Care coordination for chronic health conditions is critical to academic success, yet concrete strategies on its operationalization in schools are not well reported in the literature. Type 1 diabetes (T1D) is one such condition that requires a team-based approach to care coordination. The purpose of this study was to gain a deeper understanding of how care coordination for T1D currently operates and identify strategies for its support and facilitation in schools. METHODS Focus groups were conducted with school nurses, parents of T1D children, and providers in each of the 9 Educational Service Districts in Washington State. Recorded notes were analyzed using content analytic techniques. RESULTS Five major themes emerged from the data, each with 3 to 4 second-order themes. Care coordination depended on family, school, and child developmental contexts, knowledge/experience about T1D among school nurses, teachers, parents, and providers, access and availability of team members, communication, and relationships. CONCLUSIONS Findings highlight the importance of a contextualized and holistic perspective of facilitators and barriers to care coordination in schools. Promoting the development of supportive relationships and effective team-based approaches provides a foundation and informs intersectional care coordination for all children with chronic conditions.
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Affiliation(s)
- Mayumi Willgerodt
- Department of Child, Family and Population Health Nursing, University of Washington, Health Sciences Box 357262, 1959 NE Pacific St., Seattle, WA, 98195
| | - Kathleen H Johnson
- Department of Child, Family and Population Health Nursing, University of Washington, Health Sciences Box 357262, 1959 NE Pacific St., Seattle, WA, 98195
| | - Cara Helmer
- University of Washington School of Nursing, Health Sciences Box 357262, 11959 NE Pacific St., Seattle, WA, 98195
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Steele Gray C, Wodchis WP, Baker GR, Carswell P, Kenealy T, McKillop A, Breton M, Parsons J, Sheridan N. Mapping for Conceptual Clarity: Exploring Implementation of Integrated Community-Based Primary Health Care from a Whole Systems Perspective. Int J Integr Care 2018; 18:14. [PMID: 30127683 PMCID: PMC6095076 DOI: 10.5334/ijic.3082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 02/20/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Studying implementation of integrated models of community-based primary health care requires a "whole systems" multidisciplinary approach to capture micro, meso and macro factors. However, there is, as yet, no clear operationalization of a "whole systems" approach to guide multidisciplinary research programs. Theoretical frameworks and approaches from diverse academic traditions specify different aspects of the health system in more depth. Enabling analysis across the system, when data and ideas are captured using different taxonomies, requires that we map terms and constructs across the models. THEORY AND METHODS This paper uses concept mapping techniques to compare and contrast the theoretical frameworks and approaches used in the iCOACH project including: Ham's Ten Characteristics of the High-Performing Chronic Care System (capturing patient/carer and provider perspectives), the Organizational Context and Capabilities for Integrating Care framework (capturing the organizational perspective), and the Health Policy Monitor framework (capturing the policy system perspective). The aim of the paper is to link concepts across different theoretical framework to guide the iCOACH study. RESULTS A concept map was developed that identifies 8 overarching concepts across the heuristic models. A preliminary analysis of one of these overarching concepts, care coordination, demonstrates how different perspectives will assign different meanings, values, and drivers of seemingly similar ideas. For patients and carers care coordination is about having a responsive team of health care providers. Building relationships in teams that exist within and across different organizations is essential for providers to achieve care coordination, where managers and policy makers see care coordination as being more about creating linkages and addressing systems gaps. DISCUSSION AND CONCLUSION This work represents a first step towards development of a fully formed conceptual framework that includes key domains, concepts, and mechanisms of implementing integrated community-based primary health care.
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Affiliation(s)
- Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, CA
- Institute of Health Policy, Management and Evaluation, University of Toronto, CA
| | - Walter P. Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, CA
- Research Chair in Implementation and Evaluation Science, Institute for Better Health, Trillium Health Partners, CA
| | - G. Ross Baker
- Institute of Health Policy, Management and Evaluation, University of Toronto, CA
| | - Peter Carswell
- School of Population Health, The University of Auckland, NZ
| | - Tim Kenealy
- South Auckland Clinical School, The University of Auckland, NZ
| | - Ann McKillop
- School of Nursing, Faculty of Medical and Health Services, The University of Auckland, NZ
| | - Mylaine Breton
- Charles LeMoyne Hospital Research Center, Université de Sherbrooke, Quebec, CA
| | - John Parsons
- School of Nursing, Faculty of Medical and Health Services, The University of Auckland, NZ
| | - Nicolette Sheridan
- School of Nursing, College of Health Te Kura Haurora Tengata, Massey University, NZ
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Xiao Y. Community-based integration of management of non-communicable diseases in China. Chronic Dis Transl Med 2015; 1:133-140. [PMID: 29062998 PMCID: PMC5643567 DOI: 10.1016/j.cdtm.2015.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Indexed: 11/18/2022] Open
Abstract
Non-communicable diseases (NCDs) are a leading cause of deaths and of disease burden in China. This paper analyzes the rationale and implications of a community-based approach to a better coordinated NCDs care and management system in China. As argued by the author, the buildup of an integrated NCDs care delivery system is feasible now and large health expenditures will be saved if more stable outpatients with NCDs could be shifted to community health facilities to receive their medications. However, the key issues remain in building a general practitioner led (GP-led) primary care delivery system in China. Some prominent issues include the shortage of quality generalists, lack of proper incentives and management mechanisms, and the absence of patients and provider, and restrictive arrangements in basic health insurance policies. Even with these hard-to-solve issues, some recent reform initiatives for integrated NCDs care delivery in some localities have demonstrated originality and creativeness in developing better coordination between primary and secondary NCDs care. However, without large-scale public sector reform, innate issues with human resource development, income distribution and financing of public healthcare providers cannot be solved. It may take a long time to see deep integration of primary and secondary NCDs care in China.
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Affiliation(s)
- Yue Xiao
- Corresponding author. Tel.: +86 01082036625.
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Clark NM, Lachance L, Doctor LJ, Gilmore L, Kelly C, Krieger J, Lara M, Meurer J, Milanovich AF, Nicholas E, Rosenthal M, Stoll SC, Wilkin M. Policy and system change and community coalitions: outcomes from allies against asthma. HEALTH EDUCATION & BEHAVIOR 2015; 41:528-38. [PMID: 25270178 DOI: 10.1177/1090198114547507] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. We assessed policy and system changes and health outcomes produced by the Allies Against Asthma program, a 5-year collaborative effort by 7 community coalitions to address childhood asthma. We also explored associations between community engagement and outcomes. Methods. We interviewed a sample of 1,477 parents of children with asthma in coalition target areas and comparison areas at baseline and 1 year to assess quality-of-life and symptom changes. An extensive tracking and documentation procedure and a survey of 284 participating individuals and organizations were used to ascertain policy and system changes and community engagement levels. Results. A total of 89 policy and system changes were achieved, ranging from changes in interinstitutional and intrainstitutional practices to statewide legislation. Allies children experienced fewer daytime (P = .008) and nighttime (P = .004) asthma symptoms than comparison children. In addition, Allies parents felt less helpless, frightened, and angry (P = .01) about their child's asthma. Type of community engagement was associated with number of policy and system changes. Conclusions. Community coalitions can successfully achieve asthma policy and system changes and improve health outcomes. Increased core and ongoing community stakeholder participation rather than a higher overall number of participants was associated with more change.
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Affiliation(s)
- Noreen M Clark
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA
| | - Laurie Lachance
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA
| | - Linda Jo Doctor
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA
| | - Lisa Gilmore
- Academy for Educational Development, Washington, DC, USA
| | - Cindy Kelly
- Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, VA, USA
| | - James Krieger
- Department of Public Health, Seattle and King Country, WA, USA
| | | | - John Meurer
- Medical College of Wisconsin, Children's Hospital and Health System, Milwaukee, WI, USA
| | | | | | - Michael Rosenthal
- Department of Family Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shelley C Stoll
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA
| | - Margaret Wilkin
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI, USA
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Clark NM, Lachance L. Clark and Lachance respond. Am J Public Health 2013; 103:e2-3. [PMID: 23947331 DOI: 10.2105/ajph.2013.301535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Noreen M Clark
- Noreen M. Clark and Laurie Lachance are with the Center for Managing Chronic Disease, University of Michigan, Ann Arbor
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Childhood asthma: considerations for primary care practice and chronic disease management in the village of care. Prim Care 2012; 39:381-91. [PMID: 22608872 DOI: 10.1016/j.pop.2012.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Childhood asthma is at historically high levels, with significant morbidity and mortality. Despite more than two decades of improved understanding of childhood asthma care and the evolution of beneficial medications, widespread control remains poor, leading to suboptimal patient outcomes and quality of life. This lack of control results in excessive emergency department use, hospitalizations, and inappropriate and/or unnecessary costs to the health care system. Advanced practice models that incorporate community-based approaches and services for childhood asthma are needed. Innovative, community-included methods of care to address the burden of childhood asthma may provide examples for care of other chronic diseases.
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Muenchberger H, Kendall E, Rushton C. Pressure to perform: a content analysis of critical considerations in health coalition development. Leadersh Health Serv (Bradf Engl) 2012. [DOI: 10.1108/17511871211247633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThere is evidence that many promising coalitions fail to thrive, languishing for indefinite periods and/or collapsing before achieving their goals. The purpose of the current study is to conduct a qualitative investigation of a local coalition established to build a healthy community.Design/methodology/approachText analysis and thematic coding of coalition interviews over two separate time points provided first hand insights into the experiences of coalitions as they develop and begin to implement change.FindingsTwo overarching processes defined each phase, namely: establishing potential (development phase) and fulfilling purpose (implementation phase). At the development phase, critical considerations related to the themes of “The Local Context”, “Processes” and “Time”, whereas at the implementation phase, critical considerations were focused on “Programs”, “Information” and “Funding”. The data clearly supported a shift in attention among coalition members that could be used in a preventative manner by coalition managers.Originality/valueLeft unattended, these critical considerations may contribute to coalition under‐performance by compromising the functional integrity of the members and the entity as a whole. The processes identified in this paper offer a way of conceptualising what topics are critical to coalition members at different phases of the coalition life cycle.
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Plumb J, Weinstein LC, Brawer R, Scott K. Community-Based Partnerships for Improving Chronic Disease Management. Prim Care 2012; 39:433-47. [DOI: 10.1016/j.pop.2012.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Smith LR, Nerz P, Bryant-Stephens T, Damitz M, Lara M, Peretz P, Valencia GR, Uyeda K, Darcy N, Viswanathan M, Lesch JK, Malveaux FJ. The role of partnerships in addressing childhood asthma: the experiences of the Merck Childhood Asthma Network, Inc. (MCAN) initiative. Health Promot Pract 2012; 12:73S-81S. [PMID: 22068363 DOI: 10.1177/1524839911415263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Partnerships have taken on added importance in recent years because of their critical role in addressing complex public health problems and translating evidence-based practices to real-world settings. The Merck Childhood Asthma Network, Inc. initiative recognized the importance of partnerships in achieving the program's goals. In this article, case studies of the five Merck Childhood Asthma Network program sites describe the role of partnerships in the development and evolution of the program and its interventions. Three key factors contributed to the success of the partnerships: having common organizational goals, considering context in the selection and engagement of partners, and ensuring that each partnership benefited from the alliance. Over the 4-year program period, all five partnerships evolved, matured, and had an established goal to maintain collaboration.
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Findley S, Rosenthal M, Bryant-Stephens T, Damitz M, Lara M, Mansfield C, Matiz A, Nourani V, Peretz P, Persky VW, Valencia GR, Uyeda K, Viswanathan M. Community-based care coordination: practical applications for childhood asthma. Health Promot Pract 2012; 12:52S-62S. [PMID: 22068360 DOI: 10.1177/1524839911404231] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Care coordination programs have been used to address chronic illnesses, including childhood asthma, but primarily via practice-based models. An alternative approach employs community-based care coordinators who bridge gaps between families, health care providers, and support services. Merck Childhood Asthma Network, Inc. (MCAN) sites developed community-based care coordination approaches for childhood asthma. Using a community-based care coordination logic model, programs at each site are described along with program operational statistics. Four sites used three to four community health workers (CHWs) to provide care coordination, whereas one site used five school-based asthma nurses. This school-based site had the highest caseload (82.5 per year), but program duration was 3 months with 4 calls or visits. Other sites averaged fewer cases (35 to 61 per CHW per year), but families received more (7 to 17) calls or visits over a year. Retention was 43% to 93% at 6 months and 24% to 75% at 12 months. Pre-post cross-site data document changes in asthma management behaviors and outcomes. After program participation, 93% to 100% of caregivers had confidence in controlling their child's asthma, 85% to 92% had taken steps to reduce triggers, 69% to 100% had obtained an asthma action plan, and 46% to 100% of those with moderate to severe asthma reported appropriate use of controller medication. Emergency department visits for asthma decreased by 36% to 63%, and asthma-related hospitalizations declined by 26% to 78%. More than three fourths had fewer school absences. In conclusion, MCAN community-based care coordination programs improved management behaviors and decreased morbidity across all sites.
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Butterfoss FD. CONCLUDING REMARKS: ANTHROPOLOGY'S ROLE IN BUILDING AND SUSTAINING COMMUNITY COALITIONS. ANNALS OF ANTHROPOLOGICAL PRACTICE 2011. [DOI: 10.1111/j.2153-9588.2011.01088.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Crespo R, Shrewsberry M, Cornelius-Averhart D, King HB. Appalachian regional model for organizing and sustaining county-level diabetes coalitions. Health Promot Pract 2011; 12:544-50. [PMID: 21427262 DOI: 10.1177/1524839910377965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes a model for developing diabetes coalitions in rural Appalachian counties and presents evidence of their sustainability. The rural Appalachian coalition model was developed through a partnership between two federal agencies and a regional university. Coalitions go through a competitive application process to apply for one-time $10,000 grants. The project has funded 7 to 9 coalitions annually since 2001, reaching 66 total coalitions in 2008. Sustainability of the coalitions is defined by the number of coalitions that voluntarily report on their programs and services. In 2008, 58 of 66 (87%) coalitions in the Appalachian region continue to function and voluntarily submit reports even after their grant funds have been depleted. The factors that may contribute to sustainability are discussed in the article. This model for organizing coalitions has demonstrated that it is possible for coalitions to be maintained over time in rural underserved areas in Appalachia.
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Affiliation(s)
- Richard Crespo
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
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Coughey K, Klein G, West C, Diamond JJ, Santana A, McCarville E, Rosenthal MP. The Child Asthma Link Line: a coalition-initiated, telephone-based, care coordination intervention for childhood asthma. J Asthma 2010; 47:303-9. [PMID: 20394515 DOI: 10.3109/02770900903580835] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Childhood asthma is a complex chronic disease that poses significant challenges regarding management, and there is evidence of disparities in care. Many medical, psychosocial, and health system factors contribute to recognized poor control of this most prevalent illness among children, with resultant excessive use of emergency departments and hospitalizations for care. Recent national guidelines emphasize the need for community-based initiatives to address these critical issues. To address health system fragmentation and impact asthma outcomes, the Philadelphia Allies Against Asthma coalition developed and implemented the Child Asthma Link Line, a telephone-based care coordination and system integration program, which has been in operation since 2001. This study evaluates the effectiveness of the Child Asthma Link Line integration model to improve asthma management by measuring utilization markers of morbidity. METHODS Medicaid Managed Care Organization claims data for 59 children who received the Link Line intervention in 2003 are compared to a matched sample of 236 children who did not receive the Link Line intervention. Children in the two study groups are ages 3 through 12 years and matched on 2003 emergency department visits, age, gender, and race/ethnicity. Primary outcome variables analyzed in this study are emergency department visits, hospitalizations, and office visit claims from the follow-up year (2004). RESULTS Link Line intervention children were significantly less likely to have follow-up hospitalizations than matched sample children (p = .02). Children enrolled in the Link Line were also more likely to attend outpatient office visits in the follow-up year (p = .045). In addition, Link Line children with multiple emergency department visits in 2003 were significantly less likely to have an emergency department visit in 2004 (p = .046). CONCLUSION This coalition-developed, telephone-based, system-level intervention had a significant impact on childhood asthma morbidity as measured by utilization endpoints of follow-up hospitalizations and emergency department visits. Telephone-based care coordination and service integration may be a viable and economic way to impact childhood asthma and other chronic diseases.
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Affiliation(s)
- Kathleen Coughey
- Department of Research and Evaluation, Public Health Management Corporation, Philadelphia, Pennsylvania, USA
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Clark NM, Lachance L, Doctor LJ, Gilmore L, Kelly C, Krieger J, Lara M, Meurer J, Friedman Milanovich A, Nicholas E, Rosenthal M, Stoll SC, Wilkin M. Policy and system change and community coalitions: outcomes from allies against asthma. Am J Public Health 2010; 100:904-12. [PMID: 20299641 PMCID: PMC2853617 DOI: 10.2105/ajph.2009.180869] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2009] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed policy and system changes and health outcomes produced by the Allies Against Asthma program, a 5-year collaborative effort by 7 community coalitions to address childhood asthma. We also explored associations between community engagement and outcomes. METHODS We interviewed a sample of 1477 parents of children with asthma in coalition target areas and comparison areas at baseline and 1 year to assess quality-of-life and symptom changes. An extensive tracking and documentation procedure and a survey of 284 participating individuals and organizations were used to ascertain policy and system changes and community engagement levels. RESULTS A total of 89 policy and system changes were achieved, ranging from changes in interinstitutional and intrainstitutional practices to statewide legislation. Allies children experienced fewer daytime (P = .008) and nighttime (P = .004) asthma symptoms than comparison children. In addition, Allies parents felt less helpless, frightened, and angry (P = .01) about their child's asthma. Type of community engagement was associated with number of policy and system changes. CONCLUSIONS Community coalitions can successfully achieve asthma policy and system changes and improve health outcomes. Increased core and ongoing community stakeholder participation rather than a higher overall number of participants was associated with more change.
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Wheeler L, Buckley R, Gerald LB, Merkle S, Morrison TA. Working With Schools to Improve Pediatric Asthma Management. ACTA ACUST UNITED AC 2009. [DOI: 10.1089/pai.2009.0023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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