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The Influence of Setting on Care Coordination for Childhood Asthma
R Patrick Kelly1, Shelley C Stoll2, Tyra Bryant-Stephens3
1University of Michigan Center for Managing Chronic Disease, Ann Arbor, MI, USA rpkel@umich.edu.
Insights
Care coordination programs improved asthma management for children, particularly in underserved communities. Different settings required unique strategies, highlighting the importance of partnerships for successful implementation and integration of asthma care coordinators.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Health Disparities
Background:
- Asthma impacts 7.1 million US children, with higher burdens on African American and Latino children.
- Key barriers to asthma control include inadequate patient education and fragmented healthcare.
- Care coordination offers a promising strategy to enhance care quality and reduce health disparities.
Purpose of the Study:
- To analyze the impact of different settings on care coordination models within the Merck Childhood Asthma Network.
- To identify how organizational structures and partnerships influence the implementation of asthma care coordination programs.
Main Methods:
- Qualitative data from multiple sites were analyzed.
- The study examined the role of the setting (school, clinic, community) in care coordination delivery.
- Relationships between implementing units and clinical/population access providers were assessed.
Main Results:
- Each setting presented unique strengths and challenges for implementing care coordination.
- Sites employed distinct strategies tailored to their specific environments.
- The support and infrastructure from partner entities significantly affected participant identification and coordinator integration.
Conclusions:
- Setting significantly influences the structure and execution of asthma care coordination programs.
- Strong collaborations between lead implementers and clinical/population access providers are crucial.
- Tailored strategies and robust support systems are essential for effective asthma care coordination and reducing disparities.
Abstract:
Asthma affects 7.1 million children in the United States, disproportionately burdening African American and Latino children. Barriers to asthma control include insufficient patient education and fragmented care. Care coordination represents a compelling approach to improve quality of care and address disparities in asthma. The sites of The Merck Childhood Asthma Network Care Coordination Programs implemented different models of care coordination to suit specific settings-school district, clinic or health care system, and community-and organizational structures. A variety of qualitative data sources were analyzed to determine the role setting played in the manifestation of care coordination at each site. There were inherent strengths and challenges of implementing care coordination in each of the settings, and each site used unique strategies to deliver their programs. The relationship between the lead implementing unit and entities that provided (1) access to the priority population and (2) clinical services to program participants played a critical role in the structure of the programs. The level of support and infrastructure provided by these entities to the lead implementing unit influenced how participants were identified and how asthma care coordinators were integrated into the clinical care team.
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