The Coalition Process at Work: Building Care Coordination Models to Control Chronic Disease

Abstract

Asthma is a highly prevalent and frequently misunderstood chronic disease with significant morbidity. Integrating client services at the patient-centered level and using coalitions to build coordinated, linked systems to affect care may improve outcomes. All seven Allies Against Asthma coalitions identified inefficient, inconsistent, and/or fragmented care as issues for their communities. In response, the coalitions employed a collaborative process to identify and address problems related to system fragmentation and to improve coordination of care. Each coalition developed a variety of interventions related to its specific needs and assets, stakeholders, stage of coalition formation, and the dynamic structure of its community. Despite common barriers in forming alliances with busy providers and their staff, organizing administrative structures among interinstitutional cultures, enhancing patient and/or family involvement, interacting with multiple insurers, and contending with health system inertia, the coalitions demonstrated the ability to produce coordinated improvements to existing systems of care.

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

“…The DCAC created a Collaborative Intervention Demonstration project to show and document how teams of medical and human service providers can work together and pool their expertise and resources to address the daily chronic care needs of children who have asthma and their families who are at risk and in the inner city. At the health care system level, coalitions have also implemented care coordination and CHW programs as described by Rosenthal et al (2006) and Friedman et al (2006 [this issue]). These programs aim to improve processes of care by coordinating necessary referrals, improving prescribing and dispensing of preventive medications and equipment, and promoting continuity of care within the health care system and across other community entities.…”

Mapping for Conceptual Clarity: Exploring Implementation of Integrated Community-Based Primary Health Care from a Whole Systems Perspective

“…The connection here is a bit more obvious as inter-organizational linkages and partnerships create processes such as sharing administrative and clinical information, referral systems, and joint accountabilities that are important to cross-organizational coordination of care [16]. Similarly, at the provider level, community linkages between individual providers can enable coordination of patient care across health and social care boundaries [35]. Delivery system design specifically around team functioning, leadership and continuity are additionally key components of care coordination at the provider level.…”

Appalachian Regional Model for Organizing and Sustaining County-Level Diabetes Coalitions

“…This group process builds teamwork and collective ownership of the plan. Rosenthal et al (2006) stated that this ability to get multiple entities to work together was critical to coalitions' success. In the Appalachian model, goals and objectives are written in the Diabetes Today for Community Leaders workshop, which coalition members attend upon being awarded their grant.…”