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


Up Coming Events...

AF4Q Evaluation Team to Present at American Evaluation Association Annual Meeting

Four investigators leading the AF4Q Evaluation will conduct a panel presentation on October 18, 2014 at the 28th Annual Conference of the American Evaluation Association in Denver, Colorado.

Session Title: Evaluating a Complex Multi-Site Health Care Improvement Initiative

Session Abstract: The Aligning Forces for Quality (AF4Q) initiative is the Robert Wood Johnson Foundation's (RWJF's) signature effort to improve the quality of health care, reduce health disparities, and create models for health reform. In addition to sponsoring this 16 site program, the RWJF funds an external evaluation of the initiative. The AF4Q theory of change proposes that the alignment of multiple stakeholders working together to implement certain complimentary interventions creates synergies that will lift the overall quality of health care. This panel will begin with a presentation describing the evaluation design and challenges of collecting data on multiple interventions within a changing health care landscape. We then turn to two presentations looking more specifically at evaluation of two interrelated interventions -- physician performance measurement and reporting and quality improvement within ambulatory care settings. Finally, we will explore the intricacies of moving from a formative to a summative stage of evaluation.


Recent Publications...

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.