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Health Promot Pract. 2015 Nov;16(6):867-77. doi: 10.1177/1524839915598499. Epub 2015 Jul 31.

The Influence of Setting on Care Coordination for Childhood Asthma.

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University of Michigan Center for Managing Chronic Disease, Ann Arbor, MI, USA
University of Michigan Center for Managing Chronic Disease, Ann Arbor, MI, USA.
University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Pardee RAND Graduate School, Santa Monica, CA, USA.
Merck Childhood Asthma Network, Washington, DC, USA.
University of Illinois at Chicago School of Public Health, Chicago, IL, USA.
University of Puerto Rico, San Juan, Puerto Rico.
Los Angeles Unified School District, Los Angeles, CA, USA.


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.


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

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