Aligning Forces for Quality Evaluation

AF4Q Updates

Complex health care improvement initiatives require complex evaluation designs...

Evaluation of the Robert Wood Johnson Foundation (RWJF)’s Aligning Forces for Quality (AF4Q) program includes tracking program activities, interviewing stakeholders from different perspectives in the 16 communities funded by AF4Q, and administering national surveys to assess the impact of AF4Q interventions and identify lessons learned about the collaborative, mulitstakeholder approach to improving health care at the community level.

The broad reach of the AF4Q program puts us in a unique position to capture data and develop insights that can inform policymakers, program funders, and those working to implement health improvement interventions in communities.Through the evaluation, we hope to expand the knowledge base in the field of health services research.

While our work to provide inferences about the effect of AF4Q will extend into 2016, so far the evaluation team, which includes several university-based researchers representing multiple disciplines, has produced more than 50 articles and research summaries related to AF4Q. Early and Mid-Course Findings from the Evaluation of a National Health Improvement Initiative provides a summary of our findings and contributions to the literature, as well information on what is yet to come in the summative stage of the evaluation.

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Recent & Upcoming Events

Designing Meaningful Evaluations of Complex Health Care Improvement Initiatives

On November 13th, Dennis Scanlon led a breakfast session highlighting the challenges and successes of evaluating Aligning Forces for Quality (AF4Q). The session was a part of ALIGN, a summit to discuss what’s working—and what’s needed—to improve health care quality and reduce costs in U.S. communities.

Scanlon introduced the key aspects of the AF4Q evaluation design and discussed some of its challenges and successes. Panelists (Marsha Gold of Mathematica, Mike Furukawa of the Agency for Healthcare Research & Quality, and Rob Lott of Health Affairs) reflected on the AF4Q evaluation as well as their own approaches to complex program evaluations, and discussed how evaluations can be designed in meaningful ways to enhance the utilization of evaluation findings. A Health Affairs panelist shared insights on what they look for when reporting on evaluations of large-scale health care improvement efforts like these.

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AF4Q Evaluation Investigator to Present at the 26th Annual Scientific Symposium on Improving the Quality and Value of Health Care

Monday, December 8, 2014 | Orlando, Florida

Session Title: Impact of Community-Wide Quality Improvement on Care Management Processes Used by Medicaid-Heavy Physician Practices
Megan McHugh, Northwestern University

For more information on the symposium click here

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Recent Publications

What Is the Cost of Quality for Diabetes Care?

Initiatives working to increase health care quality and reduce cost often base their strategies on the notion that high quality preventive care combined with effective patient self-management leads to better clinical outcomes and lower costs. This study advances our understanding of this premise by looking at the relationship between cost and quality specifically for diabetes care.

To read more see this article online here.

Assessing Organizational Change in Multisector Community Health Alliances

Many policy makers and practitioners are interested in research that examines the use of multisector health alliances to improve the system of care; however, this is a challenging area of study due to the dynamic nature of multisector organizations. In this article, AF4Q Evaluation team members describe three analytic challenges that can arise when quantitatively studying the organizational characteristics of multisector health alliances: 1) assessing change in MHCA organization; 2) assessment of construct reliability, and 3) aggregation of individual responses to reflect organizational characteristics. Additionally, the authors propose a problem specific set of diagnostic and analytic approaches that may enable researchers to identify alternative explanations for observed findings, or account for limitations in the use of traditional methods when it comes to evaluating multisector health alliances. These findings may be of particular value to funders and program implementers interested in assessing and improving the functionality of collaborative organizations.

To read more, find this article online here.

Patient-Physician Role Relationships and Patient Activation: The Moderating Effects of Race and Ethnicity

Recent research has provided evidence that activated patients, or patients who are confident, knowledgeable, and take active roles in their health and health care, are more likely to engage in the types of behaviors that improve health. However, research also indicates that Black and Hispanic/Latino patients are less likely to be activated than White patients, which may be related to the interactions and relationships that minority patients have with their physicians. Using data collected through the AF4Q Evaluation’s Consumer Survey, the authors of this article explored patient-physician relationships across race/ethnicity and in relation to patient activation in order to provide insights for reducing disparities in health behaviors.

To read more, find this article online here.

Leadership Transitions in Multisectoral Health Care Alliances: Implications for Member Perceptions of Participation Value

Leadership is an important component to any mulitsectoral health care alliance but little research has focused on the impact of change in leadership on the broader group of alliance members. In this study, the AF4Q evaluation team examined the relationship between leadership transitions within alliances and how alliance members weigh the benefits and costs of participating in alliance activities. We found evidence that leadership transitions present challenges as well as opportunities depending on the timing of the transition and the ways in which the transition is managed. Through this study we were able to provide information on what transition practices could be of value to certain individuals within an organization.

To read more, find this article online here.

Why and How Six Aligning Forces for Quality Communities Have Focused on Reducing Disparities

The Aligning Forces for Quality initiative aims to increase consumer awareness and use of health care quality information. For six AF4Q communities the low rates of awareness and use among racial/ethnic minorities is of particular concern. With a focus on these six communities, we explore the activities implemented by AF4Q alliances to reduce disparities in the awareness of publicly available quality information and the ways in which alliances use the power of collaboration to enhance these efforts. By looking at the experience of these alliances we see evidence that community partnerships are a promising mechanism for increasing awareness of quality information in minority communities. This study provides one example for how AF4Q is creating models for health care improvement and disparities reduction in the United States.

To read more, see this article online here.

What Influences the Awareness of Physician Quality Information? Implications for Medicare

Many organizations and initiatives, including AF4Q and Medicare’s Physician Compare effort, are working to report physician performance and raise awareness of physician quality among health care consumers. In this study we used data collected as part of the AF4Q evaluation effort to examine awareness of physician quality reports among people 65 and older who have chronic illnesses.

We found that awareness of physician quality information among this population is relatively low, similar to awareness in the general population. Furthermore, there is little difference in awareness across demographic subgroups. For this and other reasons, Medicare is not likely to be able to raise the overall awareness of beneficiaries significantly through targeted outreach programs. However, it is worth noting that awareness of physician performance information on the part of even a minority of Medicare beneficiaries, combined with a willingness to act on the information they contain, may be sufficient to drive quality improvement efforts on the part of physicians.

To read more, find this article online here.

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About the AF4Q Evaluation

The Aligning Forces for Quality (AF4Q) initiative is the Robert Wood Johnson Foundation’s signature effort to lift the overall quality of health care in targeted communities, reduce racial and ethnic disparities and provide models for national reform.

The AF4Q Evaluation conducts impartial mixed methods research to provide inferences about the effect of AF4Q, identify key lessons about the AF4Q program design and implementation, and expand the knowledge base around health care reform at the local level. To measure the impact of the AF4Q initiative, we place particular emphasis on measurable progress in five key areas:

  • Consumer Engagement
  • Quality Improvement
  • Performance Measurement and Public Reporting
  • Payment Reform
  • Disparities Reduction

Learn more about our evaluation design in a 2012 special edition of the American Journal of Managed Care:

Evaluating a Community-Based Program to Improve Healthcare Quality: Research Design for the Aligning Forces for Quality Initiative