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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?