Aligning Forces for Quality Evaluation - Research Areas

To measure the impact of the AF4Q initiative, the AF4Q Evaluation places particular emphasis on measurable progress in four key areas:

Consumer Engagement

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Consumer engagement involves encouraging patients to become active managers of their own health and to make informed choices about their doctors, hospitals, and health care. Patients who are informed make better choices, which can ultimately lead to better outcomes and reduced costs. To make better choices, patients need to understand risk behaviors, learn how to manage chronic illness, and work with their doctors to select treatment options. Consumers should demand good care and choose health care providers that deliver effective, quality care.

As part of AF4Q, alliances are developing and implementing strategies to increase consumer engagement. Specific initiatives vary by site, but focus on: educating and engaging consumers to use health information and alliance performance reports to inform key health care decisions, tracking visits to and downloads of web-based provider performance reports, and assessing the degree to which the websites and reports are consumer-friendly.

Performance Measurement and Public Reporting

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Performance measurement and public reporting involves using widely-accepted standards to measure the quality of care delivered by providers and the public sharing of that performance information. Measurement and reporting is critical to improving the quality of health care and it impacts the decision-making of patients, providers, and purchasers of care (i.e., employers). Patients need access to performance data in order to choose effective providers; Providers need the data to improve the care they give to patients; and purchasers may use the same data to assess where to target financial resources.

The AF4Q sites are engaged in expanding performance measurement and public reporting in their communities. Initiatives surrounding this domain vary by site, but focus on collecting performance data on at least half of the community's primary care physicians and producing performance reports that will be reviewed by physicians and made publicly available. These reports aim to: stratify performance measures by race and ethnicity, include a National Quality Forum (NQF)-endorsed measure (s) of ambulatory care experience, incorporate inpatient performance measures such as patient experience, and identify health care efficiency measures and the mechanism to collect data on those measures.

Quality Improvement

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Quality improvement involves implementing techniques and protocols that help doctors and hospitals raise the level of care they deliver. These techniques increasingly involve lifting the performance of the entire system, not just individuals. This system-wide focus encourages doctors to: work in teams, identify problems and solutions related to medical errors, and implement evidence-based quality improvements.

All 17 AF4Q sites have been asked to consider ways to create a permanent quality improvement resource in their community. Approaches vary by state, but focus on developing plans for local ambulatory quality improvements; encouraging hospitals to enroll in quality improvement collaboratives, which focus on patient-centered care or reducing disparities, and developing plans and standardize training for collecting self-reported patient race, ethnicity, and language.

Disparities Reduction

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AF4Q emphasizes improvements in care for all patients, including patients from all racial and ethnic backgrounds. AF4Q's disparities domain focuses on examining the factors which may have an impact on the provision of high quality equitable care for racial, ethnic, and linguistic minorities and other underserved populations. Because disparities are markers of poor quality of health care, as a first step, the disparities domain team will examine how the AF4Q markets are collecting and using self-reported race, ethnicity, and primary language data as a foundation for reducing disparities in health care quality.

At the health care system level, several factors contribute to disparities including fragmentation of care, financial and physical barriers, information barriers, differential access to high-quality care, and communication or cultural barriers. It is difficult to assess where and why disparities exist without collecting and stratifying quality data by race, ethnicity, and primary language. We know that health care providers and health plans currently either do not collect race, ethnicity, and primary language data or do not collect it systematically.

Our efforts will focus on how the AF4Q communities are collecting and using data to reduce health care disparities. In addition, we will examine the integration of disparities reduction with activities related to quality improvement, consumer engagement, and performance measurement and public reporting as well as the role of governance and leadership in reducing disparities in the AF4Q communities.