Aligning Forces for Quality 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

Upcoming Publications

Publication Title:

Governance Processes and Change Within Organizational Participants of Multi-sectoral Community Health Care Alliances: The Mediating Role of Vision, Mission, Strategy Agreement and Perceived Alliance Value.

Appearing In:

American Journal of Community Psychology

(online ahead of print)


Larry R. Hearld and Jeffrey A. Alexander

See this Article Online Now

One factor contributing to the sustainability of multi-sectoral community health alliances is the extent to which the vision, goals, and programs established by alliances are institutionalized within participating organizations and the broader community. This study draws from three rounds of the AF4Q Evaluation’s Alliance Survey to investigate mechanisms by which alliance leadership and management processes may promote changes that reinforce the work of the alliance within participating organizations.

Publication Title:

Pay-for-Performance and Public Reporting Program Participation and Administrative Challenges Among Small- and Medium-Sized Physician Practices

Appearing In:

Medical Care Research and Review (online now)


Larry R. Hearld, Jeffrey A. Alexander, Yunfeng Shi, Lawrence P. Casalino

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The use of public reporting and pay-for-performance programs is key in the effort to improve health care quality in the United States. Many large physician practices participate in these programs and report success; however, little is known about the participation and impact of these programs on smaller physician practices. This study takes a closer look at the participation of small and medium-sized physician practices in public reporting and pay-for-performance programs. Based on the findings of this study, the authors suggest a number of features that may be used to foster greater participation from smaller practices in the future.

Recent Presentations

Scientific Symposium on Improving the Quality and Value of Health Care at the Institute for Healthcare Improvement 25th Annual National Forum

  • December 9, 2013, Orlando, Florida

    Measuring the Dose of Community-Level Quality Improvement Interventions (Harvey): We identify three different approaches for measuring QI dose, apply them to a quality improvement initiative launched in 14 communities (The Aligning Forces for Quality initiative), report on the extent to which they consistently identify “high” or “low” dose communities and the extent to which they are associated with changes in QI outcomes in four domains: receipt of recommended care, care coordination, patient satisfaction, and patient experience.

    Impact of a Community-Wide Quality Improvement Initiative on Chronic Illness Care: Interim Findings from the Aligning Forces for Quality Program (Harvey): In this study we determine whether AF4Q communities experienced greater improvements than a comparison group on four quality dimensions: receipt of recommended care, care coordination, patient satisfaction and patient experience.

See More AF4Q Evaluation Work on Quality Improvement