Coalitions: A Promising Way to Enhance Asthma Control Noreen M. Clark, Ph.D. School of Public Health University of Michigan

Patient Self- Management Family Involvement Clinical Expertise Work/School Support Community Awareness & Action Environmental Measures Conducive Policies

Some Assumptions about Effective Asthma Coalitions: n integrate expertise of health professionals, patients, and lay persons n derive momentum from community interest and concern n coordinate asthma - directed initiatives

Some Assumptions about Effective Asthma Coalitions: n produce intermediate outcomes (e.g. across institutions/sectors, management skills, referral systems) n intermediate outcomes contribute to alternate desired health outcomes (e.g. patient health status, health care use)

Outputs more anti- inflamm. use more anti- inflamm. use patient action plans provided patient action plans provided increased patient self mgmt. increased patient self mgmt. availability of reimbursement availability of reimbursement more continuity of care more continuity of care surveillance systems surveillance systems using meds at school using meds at school etc. etc. Health Related Outcomes fewer symptoms fewer symptoms less health care use less health care use better quality of life better quality of life improved school attendance improved school attendance etc. etc. Coalition Processes membership membership leadership leadership participation participation relationships relationships etc. etc.Coalition Input Input clinician education clinician education patient education patient education redesign of services redesign of services educate payors/ fiduciaries educate payors/ fiduciaries policy initiatives policy initiatives etc. etc.

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

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

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NHLBI and RWJF Collaboration to Explore Coalitions n NHLBI - support and assistance to 8 coalitions n RWJF: Allies Against Asthma - funding and technical assistance to 8 coalitions n Jointly: Coalition meetings, shared information, coordinated assistance, etc.

Allies Against Asthma

National Advisory Committee - Members

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

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

Research questions: n Are coalition activities associated with desired health outcomes? n In what ways do coalitions produce results different/better than other types of intervention? n What characterizes a successful coalition?

Research questions: n What elements of coalition activity are most effective? n How can coalition effectiveness be enhanced? n How can coalition efforts be institutionalized?