title: The Influence of Setting on Care Coordination for Childhood Asthma.
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.
authors.affiliation: University of Michigan Center for Managing Chronic Disease, Ann Arbor, MI, USA rpkel@umich.edu.
authors.forename: R Patrick
authors.initials: RP
authors.lastname: Kelly
authors.affiliation: University of Michigan Center for Managing Chronic Disease, Ann Arbor, MI, USA.
authors.forename: Shelley C
authors.initials: SC
authors.lastname: Stoll
authors.affiliation: University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Tyra
authors.initials: T
authors.lastname: Bryant-Stephens
authors.affiliation: University of Michigan Center for Managing Chronic Disease, Ann Arbor, MI, USA.
authors.forename: Mary R
authors.initials: MR
authors.lastname: Janevic
authors.affiliation: Pardee RAND Graduate School, Santa Monica, CA, USA.
authors.forename: Marielena
authors.initials: M
authors.lastname: Lara
authors.affiliation: Merck Childhood Asthma Network, Washington, DC, USA.
authors.forename: Yvonne U
authors.initials: YU
authors.lastname: Ohadike
authors.affiliation: University of Illinois at Chicago School of Public Health, Chicago, IL, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Persky
authors.affiliation: University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Ramos-Valencia
authors.affiliation: Los Angeles Unified School District, Los Angeles, CA, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Uyeda
authors.affiliation: Merck Childhood Asthma Network, Washington, DC, USA.
authors.forename: Floyd J
authors.initials: FJ
authors.lastname: Malveaux
mesh_terms: D001249:Asthma / Q000628:therapy*; D002648:Child; D003142:Communication; D003153:Community Health Services / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004777:Environment; D006266:Health Education / Q000458:organization & administration; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration; D012572:School Health Services / Q000458:organization & administration*; D012947:Social Work / Q000458:organization & administration; D014481:United States; D014505:Urban Population
keywords: asthma; child/adolescent health; environmental and systems change; health disparities; health promotion; lay health advisors/community health workers; medical care; partnerships / coalitions; qualitative evaluation; school health