Improving Quality of Care and Promoting Health Care System Change: The Role of Community-Based Coalitions

Abstract

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.S. health care system--motivation to change the status quo, integration across systems, and accountability for results. The collaborative and empowering processes that a coalition model encourages and the direct advocacy opportunity provided to the consumer appear to bring these forces into play.

Reducing Quality-of-Care Disparities in Childhood Asthma:La Red de Asma InfantilIntervention in San Juan, Puerto Rico

“…7,[16][17][18] The adaptation of the interventions was guided by the conceptual model shown in Fig 1 that draws on structural, process, and outcome components first defined by Donabedian and applied here in the context of a community-based intervention. 17,18 Structural core elements include the material resources, characteristics of the physical/socialorganizational setting, and the number and qualifications of staff. 18,19 Process core elements consist of the protocol including how, when, and by whom the intervention is delivered.…”

Community-Based Approaches to Controlling Childhood Asthma

“…They work to develop or modify existing policy and bring about changes in clinical and community systems (for example, health systems and school districts) to enable more effective disease management. They are seen as an especially promising community-based approach (55). However, there have been only two rigorous evaluations of the work of community coalitions for asthma control.…”

Translation of an evidence-based asthma intervention: Physician Asthma Care Education (PACE) in the United States and Australia

“…When these extra requirements are not needed, participation levels are higher. 22 Strengths and limitations of this study RE-AIM has been used to plan, evaluate, and review a variety of health promotion and disease management interventions and has appeared in over 150 published studies. 23 As an assessment tool, RE-AIM proved useful in framing the important dimensions of assessment and those most important for ensuring reach, impact, and sustainability.…”