Policy change as a result of community coalitions

Community coalitions are seen as a way of getting a range of stakeholders, including those who usually don't interact to collectively address a health problem. Coalitions aim to reach large populations, perhaps entire communities with benefits. Evaluative data on the accomplishments of coalitions related to health outcomes has been contradictory and/or scant. Making optimum the power of coalitions to effect change requires understanding how they work to achieve outcomes. This study evaluated the work of 7 coalitions around the country aiming to improve asthma outcomes for poor and minority children. The study evaluation model collected three types of data related to: a) the processes common to functioning and success across the coalitions; b) the intermediate outcomes, that is, achievements that were expected to lead to reduced morbidity and mortality; c) long term health related outcomes for children e.g. reduced symptoms, hospitalizations and emergency department visits for asthma, and improved quality of life for families. Intermediate policy related outcomes were among the most crucial coalition accomplishments. They were levers to change that held the most promise for large scale impact. Policies were related to change in a single institution and across institutions and within a single neighborhood and across neighborhoods. Eight policy changes were evident: community wide patient registries (3); care coordination across community facilities (2); integration of community health workers and clinical care (3); community wide education for clinicians (7); environmental control (1); standardized asthma action plans across institutions (3); links between health facilities and schools (6);intra institutional coordination (7).