title: Improvements in health care use associated with community coalitions: long-term results of the allies against asthma initiative.
abstract: OBJECTIVE
  We assessed changes in asthma-related health care use by low-income children in communities across the country where 6 Allies Against Asthma coalitions (Hampton Roads, VA; Washington, DC; Milwaukee, WI; King County/Seattle, WA; Long Beach, CA; and Philadelphia, PA) mobilized stakeholders to bring about policy changes conducive to asthma control.
  
  
  METHODS
  Allies intervention zip codes were matched with comparison communities by median household income, asthma prevalence, total population size, and race/ethnicity. Five years of data provided by the Center for Medicare and Medicaid Services on hospitalizations, emergency department (ED) use, and physician urgent care visits for children were analyzed. Intervention and comparison sites were compared with a stratified recurrent event analysis using a Cox proportional hazard model.
  
  
  RESULTS
  In most of the assessment years, children in Allies communities were significantly less likely (P < .04) to have an asthma-related hospitalization, ED visit, or urgent care visit than children in comparison communities. During the entire period, children in Allies communities were significantly less likely (P < .02) to have such health care use.
  
  
  CONCLUSIONS
  Mobilizing a diverse group of stakeholders, and focusing on policy and system changes generated significant reductions in health care use for asthma in vulnerable communities.
authors.affiliation: Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI 48109-2029, USA. nmclark@umich.edu
authors.forename: Noreen M
authors.initials: NM
authors.lastname: Clark
authors.forename: Laurie L
authors.initials: LL
authors.lastname: Lachance
authors.forename: M Beth
authors.initials: MB
authors.lastname: Benedict
authors.forename: Linda Jo
authors.initials: LJ
authors.lastname: Doctor
authors.forename: Lisa
authors.initials: L
authors.lastname: Gilmore
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Kelly
authors.forename: James
authors.initials: J
authors.lastname: Krieger
authors.forename: Marielena
authors.initials: M
authors.lastname: Lara
authors.forename: John
authors.initials: J
authors.lastname: Meurer
authors.forename: Amy Friedman
authors.initials: AF
authors.lastname: Milanovich
authors.forename: Elisa
authors.initials: E
authors.lastname: Nicholas
authors.forename: Peter X K
authors.initials: PX
authors.lastname: Song
authors.forename: Michael
authors.initials: M
authors.lastname: Rosenthal
authors.forename: Shelley C
authors.initials: SC
authors.lastname: Stoll
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Awad
authors.forename: Margaret
authors.initials: M
authors.lastname: Wilkin
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001249:Asthma / Q000208:ethnology / Q000517:prevention & control*; D002140:California; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004219:District of Columbia; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006265:Health Care Coalitions; D006293:Health Promotion; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D015143:Philadelphia; D011203:Poverty; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D014481:United States; D014768:Virginia; D014861:Washington; D014922:Wisconsin