1. Coalitions: Integrating Community-Based Asthma Control Strategies
Jim Krieger, MD, MPH
Bob Groves, MA, MPH
Marielena Lara, MD, MPH
Kimberly Wicklund, MPH
April 2004

2. Concepts of Integration
Service coordination
Consistent and coherent services
Linkage and cross-referral among providers
Cross-institutional Collaboration
Shared vision
Shared resources
Exchange of data
Coordinated/joint program implementation
United advocacy
Multi-disciplinary Collaboration

3. Ladder of Integration Joint Action Coordinated Action Cross-Referral
Joint program development
Coordinated Action
Coordinated but independent components
Joint: Agencies interested in asthma education design single program
Coordinated actions: Quality improvement collaborative
Cross referral: CHW to Primary care; Primary care to community education and support programs, education/support to CHW
Mutual awareness: directories, shared information
Cross-Referral
Independent programs refer clients to each other
Mutual Awareness
Programs aware of one another

4. Barriers to Integration
Structural
Silos
Staff not available to participate in integration work
Leadership not available to provide direction
Cultural and Personal
Doing it your way
Turf and control
Logistical
Working out the details
Time for communicating and coordinating
Fiscal
Pressures to generate revenues
Competition
Proliferation of action plans
Development of disease management systems by health plans independently of providers
Reluctance of providers and CBOs to change current practices to conform with standardized guidelines
High value on organizational autonomy

5. Overcoming Barriers: Coalitions Bring Together Sectors
Safe, neutral space
Forum to network and learn
Common vision
Leadership
Coordination of resources

6. Overcoming Barriers: Coalition 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
Champions for integration
Need few people committed to integration, determined to keep it going
Collaborative program development
KC: EPA grant links childcare provider training with AAA CHWs
Members
Managed Care Organizations
Medicaid Program
Hospitals
Emergency Departments
Clinics
Physicians
Community Health Workers
Nurses
UniversitiesALA
AAFA
CBOs
Community Asthma Programs
Community Residents
Faith-based Organizations
School Districts
Coalition Staff
Public Health
DHHS

7. 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

8. Philadelphia Link Line
STEP 1- REFERRALS
Family consents to Service
Referrals made by Hospital Emergency Department, Schools, Community Organizations, Primary Care Providers or Self Referrals
Consent and Patient Demographics sent to Asthma CALL Center via confidential FAX or Brochure
STEP 2- CALL CENTER SERVICE
.Intake form received and information logged into computer
.Power Pack of asthma literature sent to family by mail
.Care Coordinator contacts family member and conducts a telephonic needs assessment (60 item questionnaire)
.Care Coordinator determines barriers to care makes recommendations for programs/services available that address their needs
.Care Coordination and Family member develop a verbal action plan with list of resources they can be linked to for care
.Client information logged into computerized database
STEP 3- FOLLOW-UP
Information from client encounter sent to Managed Care Asthma Disease Case Manager or other service provider with reciprocal agreement
Follow up calls with family every month for 4 months

9. 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

10. Integration Across Organizations
Community Asthma Action Plan
Summary of shared vision
Developed in a participatory, collaborative process
Defines roles
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

11. Integration Across Organizations
Common tools, guidelines and messaging
Single asthma action plan
Shared educational resources and programs
Consistent asthma control protocols and guidelines
Consistent key asthma messages
Asthma Team (Long Beach): Parents, teachers, coaches, providers, etc…use coalition to change expectations for asthma care and help team members understand roles and responsibilities.
Integrated education:
Philly: integrate asthma 101 and smokeless home presentations
KC: integrate asthma 101 into childcare trainings

12. Integration Across Organizations: Sharing Data and Information
Health Plan Data
Utilization/Registries
Pharmacy
ED Data
Utilization
Provider Data

13. Integration Across Organizations Coordination of Asthma Policy/Advocacy
Better Housing
Breathe Easy Units
Cleaner Air
Diesel
Reimbursement
Community Health Workers
Chronic disease management
Asthma education

14. Examples:
Link clinics and schools via CHW
Link clinics to commuity resources (classes and CHWs)
Link health plans and clinics for QI
Link childcare providers to public health for education and indoor env. assessments

15. Fight Asthma Milwaukee

16. Future Directions Policy and advocacy Bringing to scale
Sustaining integration

17. 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.
“unnatural act among non-consenting partners”
Thank you and I look forward to hearing about the all the experiences you have had in walking down this road.