Childhood asthma: considerations for primary care practice and chronic disease management in the village of care.

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.

The Child Asthma Link Line: a coalition-initiated, telephone-based, care coordination intervention for childhood asthma.

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.

Integrating asthma prevention and control: the roles of the coalition.

Activities addressing pediatric asthma are often fragmented. Allies coalitions promoted integration, the alignment of concurrent asthma control activities across and within sectors. Systems integration describes activities from an organizational perspective.

The coalition process at work: Building care coordination models to control chronic disease.

Asthma is a highly prevalent and frequently misunderstood chronic disease with significant morbidity. Integrating client services at the patient-centered level and using coalitions to build coordinated, linked systems to affect care may improve outcomes. All seven Allies Against Asthma coalitions identified inefficient, inconsistent, and/or fragmented care as issues for their communities.

Allies community health workers: Bridging the gap.

Allies Against Asthma coalitions each employ a community health worker (CHW) program as part of its community action plan. The structure and management of CHW programs vary in response to the resources and needs of the local community, as do the roles and characteristics of the CHWs hired. All programs utilize CHWs to provide community-based education and/or outreach to community members, primarily in their homes.

Improving quality of care and promoting health care system change: The role of community-based coalitions.

As part of their community action plans, the Allies Against Asthma coalitions have developed efforts to improve quality of care and promote health care system change. All the coalitions have used an interdisciplinary collaborative approach to design these strategies and demonstrated a range of intervention approaches appropriate to their local context and circumstances. The coalitions' collective experience suggests that coalitions provide three key forces for quality improvement and change that may be lacking in the current fragmented U.

From formation to action: How allies against asthma coalitions are getting the job done.

Coalitions develop in and recycle through stages. At each stage (formation, implementation, maintenance, and institutionalization), certain factors enhance coalition function, accomplishment of tasks, and progression to the next stage. The Allies Against Asthma coalitions assessed stages of development through annual member surveys, key informant interviews of 16 leaders from each site, and other evaluation tools.