Recorded presentation

Michael P. Rosenthal, MD, Department of Family Medicine, Jefferson Medical College, 1015 Walnut Street, Suite 401, Philadelphia, PA 19107, 215-955-2351, michael.rosenthal@jefferson.edu, John R. Meurer, MD, MBA, Pediatrics (Community Care), Medical College of Wisconsin, 8701 Watertown Plank Road, MFRC CAUC, Milwaukee, WI 53226-0509, Lisa Gilmore, MBA, MSW, DC Asthma Coalition, 475 H Street, NW, Washington, DC 20001, and James Krieger, MD, MPH, Epidemiology, Planning and Evaluation Unit, Public Health - Seattle & King County, 999 Third Ave, Suite 1200-EPE, Seattle, WA 98104.

Background: Health system fragmentation and lack of coordinated approaches have limited the effectiveness of controlling chronic diseases such as asthma. The Allies Against Asthma Coalitions have developed strategies for integrating multiple levels and types of efforts to reduce fragmentation and improve outcomes.

Integration methods: Allies Coalitions have developed structure and integrated efforts as an intermediate step toward improving asthma care and control in each of their communities.

Increased coordination has enhanced transition from disparate entities to integrated partnerships by using systems building (e.g. steering committees, cross-institutional interventions, common guidelines, shared resources) and service linkages (e.g. cross-referral mechanisms, client tracking, community health worker care coordination, cross-provider communication).

Levels of integration have included: a) care of the individual, family, and provider, b) care among emergency departments, providers, health departments, and home health care, c) coordination of efforts by managed care organizations, providers, healthcare institutions, and governments, and d) education and environmental efforts among families, homes, schools, providers, health plans, and community agencies. Importantly, each coalition has developed its own emphasis on system integrations, and the Allies multi-initiative integration has led to synergistic considerations for new, innovative models of health care delivery.

Conclusions: Bringing multi-level integration to asthma control efforts impacts the myriad of concerns identified in a fragmented health care system. It establishes partnerships of healthcare agencies, providers, and community members, and helps to unite them around common goals. The successful, intermediate outcome of integrated approaches will be a key component in developing models to reduce asthma morbidity and mortality.

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