Addressing asthma health disparities: Results of a hybrid model linking clinics and coalitions

The Massachusetts Department of Public Health's Asthma Disparities Initiative (ADI) is defined by a unique collaboration between clinics and community-based asthma prevention coalitions, referred to as the ‘hybrid' model. The aim of the model is to bring the clinic and community closer, through sharing of resources, coordinated programming, joint outreach, and leveraged policy advocacy in the community. Additionally, the model employs use of a Community Health Worker (CHW) in clinics who support families at the health centers, conduct patient home visits, and who join and further the work of the community coalitions by sharing information and insights and by recruiting broader participation by family members whose children have asthma. Prior research has found positive gains from interventions that employ CHW to address asthma disparities. At the same time, meta-analysis of asthma coalition work has identified greater impact on health outcomes when coalitions are clinically-connected. Using the CDC formative evaluation framework which emphasizes broad stakeholder engagement throughout the process, two pilot ADI sites were evaluated to ascertain the challenges, benefits, and recommendations for implementing a hybrid model. While a number of factors affect launching such an approach, the evaluation found that CHW were able to serve as a bridge between clinics and communities, clinical teams benefited from what they learned from coalitions, and coalitions were able to leverage support from clinics in their local outreach and advocacy work. While working with a limited sample size, trends seem to indicate enhanced asthma self-management, reduction in asthma trigger factors, and improved health outcomes.