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Coalitions: Integrating Community-Based Asthma Control Strategies. Jim Krieger, MD, MPH Robert Groves, MA, MPH Marielena Lara, MD, MPH Kimberly Wicklund, MPH November 2003. Concepts of Integration. Service coordination Providing asthma services coherently and consistently - PowerPoint PPT Presentation
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Coalitions: Integrating Community-Based Asthma
Control Strategies
Jim Krieger, MD, MPH
Robert Groves, MA, MPH
Marielena Lara, MD, MPH
Kimberly Wicklund, MPH
November 2003
Concepts of Integration
• Service coordination– Providing asthma services coherently and
consistently– Linking providers to assure delivery of full range
of services
• Cross-institutional Collaboration– Developing a shared vision– Sharing resources– Joining in program implementation and
advocacy
• Multi-disciplinary Collaboration
Families Want Integration
“Nurses, doctors, and parents need to connect. We all want to be involved and we want to know what’s going on with our kids.”
Primary Care Providers Want Integration
• Don’t know when kids admitted to ED or hospital
• Don’t know if medications are refilled
• Aren’t connected to schools and childcare
Barriers to Integration• Structural
– Silos– Staff not available to participate in integration work– Leadership not available to provide direction
• Cultural– Doing it your way– Turf and control
• Logistical– Working out the details– Communicating and coordinating are time-consuming
• Pressures to generate revenues, meet performance
targets
Paradox of Integration
While an integrated system will ultimately be more efficient and
effective, getting there takes time and may appear inefficient
Overcoming Barriers:Coalitions Bring Together Sectors
• Safe, neutral space • Forum to network and learn• Common vision• Leadership • Coordination of resources• Build relationships
Coalition MembershipPlease circle the category (organization) that applies to you
CSAS
N=294
Health Care Provider 38%(32-45%)
Community 22%(8-48%)
School 11%(2-21%)
Other 13%(6-21%)
HMO 7%(3-12%)
Health Department 15%(3-34%)
Coalition MembershipGroups not well represented
Category All Range
Health depts. 9.9% 4-24%
Community org. 44.2% 18-55%
Providers 15.0% 4-24%
Schools 5.8% 0-18%
HMO 8.5% 0-28%
Residents 31.3% 12-45%
CSAS
N=294
Other includes media, business, faith-based, housing, elected officials and staff
Coalition Membership
Does the coalition have sufficient representation to accomplish objectives?– Yes: 70%– Range: 33-90%
CSAS
N=294
Overcoming Barriers:Steering Committees
• Primary mechanism for integration• Decision-making body of coalition• Gathering of organizational decision-
makers• Champion for integration• Strategic planning• Collaborative approach to grant-writing
and new program development
Overcoming Barriers:Steering Committees
• Managed Care Organizations
• Medicaid Program• Hospitals• Emergency Departments• Clinics• Physicians• Community Health
Workers• Nurses• Universities
• ALA• AAFA• CBOs• Community Asthma
Programs• Community Residents• Faith-based Organizations• School Districts• Coalition Staff• Public Health• DHHS
Integrating Care For Individuals
• Community Health Workers– Link families with schools, childcare,
health providers, public housing– Advocate for families for
accessibility and consistency of services
• Care Coordinators– Facilitate access to services– Coordinate services across service
providers– Back-up CHWs
• Individual Asthma Action Plans
Philadelphia Link Line
1Emergency Department Children's’ Hospitals
Elementary Schools Philadelphia School Dist.
Community Based Sites
Care Coordination/Case Management Fight Asthma Milwaukee
• ED or clinic notifies care coordinator at local health department
• Coordinator arranges linkage to appropriate services– Home visits by nurse case manager:
– Home visits by health department environmental inspector
– Calls to encourage follow-up with medical home
– Refer to parent mentor program
– Refer to family asthma education
– Info about childcare/school asthma education
• Shared evaluation and educational protocols
Care CoordinationAlianza, Puerto Rico
Nurse clinical coordinator
• respected and accepted by community
• works with community health care workers to coordinate care
• links patients with MCO, local and state health departments, and other agencies of the coalition.
Cross-Project Integration GroupKing County Asthma Forum
• Single asthma referral phone number• Staffed by community health workers• Refer to coalition member services– home visits (Allies, Healthy Homes, MHE)– public health nurses– primary care– family education groups
• Triage protocols• Joint outreach and recruitment
Integration Across Organizations
• Community Asthma Action Plan– Summary of shared vision– Developed in a participatory, collaborative process– Defines roles
• Develop multiple forums to foster integration– Coalitions as the overarching roof– Cross-project coordination groups– Learning collaboratives for clinics– Joint proposals and projects– Conferences and community meetings
Integration Across Organizations
• Asthma team• Common tools, guidelines
and messaging– Single asthma action plan– Shared educational
resources and programs– Consistent asthma control
protocols and guidelines– Consistent key asthma
messages
Integration Across Organizations
Linking Providers and CHWs
• King County– Learning Collaborative – Quality Improvement (Improvement Model)– Registry prompts– Systematized referral and communication
• Long Beach– Provider education (PACE)– Fax referrals to CHWs
Integration Across Organizations
Coordination of Asthma Policy/Advocacy
• Long Beach– Better Housing: Providers and Landlords– Cleaner Air: Parents, Residents, Legislators,
Schools, Environmental Groups
• King County– Public Housing– Medicaid reimbursement
Future Directions
• Integrating beyond asthma– Tobacco control– Other chronic conditions: STEPS
• Policy and advocacy• Bringing to scale• Sustaining integration
To conclude:
• Integration doesn’t come easily but there are effective strategies to help get there.
• Paths to integration will vary by community and must fit the local landscape.