Initiated in 2001, Controlling Asthma in the Richmond Metropolitan Area (CARMA) is one of seven initiatives selected for the Controlling Asthma in American Cities Project, funded by the Centers for Disease Control and Prevention. This project targets children aged 2–18 and their families, using community-based interventions that include education, intensive case management for high-risk children, and health care provider education. Project efforts include managed care collaboration and parish nurse/lay outreach partnerships. Also, linkages between obesity and asthma are being explored. The Bon Secours Richmond Health System, the University of Virginia Health System, and the Central Virginia Asthma Coalition are partners in this initiative, which includes annual assessments of effectiveness, cost, collaborative relationships, and feasibility of expansion. Long-term outcomes will be assessed by tracking hospitalizations and emergency department visits.
The Pediatric/Adult Asthma Coalition of New Jersey (PACNJ), sponsored by the American Lung Association of New Jersey, is a state-level consumer-driven initiative formed in 2000 to provide the state with a clearinghouse for asthma programs and services. It currently uses six task forces to ensure that all public and private educational and child care facilities, physicians, and other providers comply with the National Heart, Lung, and Blood Guidelines for asthma management. PACNJ has been involved in the development of a state-mandated asthma action plan for any child carrying an inhaler in school and has provided school nurse education, with pre- and post-tests, via satellite broadcast. Its health insurance task force has developed guidelines for standards of care related to asthma treatment, based on findings from a conference on best practices for public and private New Jersey insurers. Current projects are focused on patient self-management tools for recognizing asthma severity and controlling asthma triggers in the home and school.
The Philadelphia Department of Health is one of 12 recipients nationwide of the Department of Health and Human Services’ Steps to a HealthierUS grant. This initiative supports community-based programs designed “to help Americans live longer, better, and healthier lives” by reducing the burden of asthma, diabetes, and obesity. Steps funding will enhance programs already under way in Philadelphia, such as an asthma call center (Child Asthma Link Line) that links children who have presented at local pediatric emergency departments with acute asthma exacerbations to specialists and other community resources, such as asthma self-management education programs and programs to eliminate home environmental triggers. Future plans are to expand this care coordination model to other chronic diseases, starting with diabetes. The Asthma Call Center was established in partnership with the Philadelphia Allies Against Asthma Coalition and is funded by a grant from The Robert Wood Johnson Foundation.
Intermountain Health Care (IHC)—an integrated delivery system that includes providers, plans and hospitals—has focused on management of depression in primary care settings within the framework of the Chronic Care Model. This initiative provides the primary care clinician, patient, and family with the tools and organizational supports needed to identify, diagnose, treat, and manage depression. The effort, begun in 1999, has