Key Research Areas
To measure the impact of the AF4Q initiative, the AF4Q Evaluation places particular emphasis on five key areas:
The AF4Q theory of change is rooted in the notion that multiple stakeholders working together can create more positive change than any one sector could accomplish alone. The AF4Q evaluation team studies the various paths taken, successes, and challenges faced by the alliances as they work to align stakeholders with differing agendas, establish agreed upon goals and strategies for change, implement their work, and ultimately sustain alliance activities within 16 diverse environments.
In designing the AF4Q program, RWJF viewed consumer engagement as one of the key drivers to improving the overall quality of health care in the United States. More specifically, AF4Q focused on improving patient self-management of health and health care, and encouraging consumer choice of high-quality health care providers. To achieve this, alliances integrated consumer voices into their leadership and decision-making, and convened consumer workgroups to develop implementation strategies. The AF4Q evaluation team explores the various aspects of this approach.
As the health care transparency movement has evolved, AF4Q has put substantial effort into improving access to health care cost and quality information. The AF4Q evaluation team tracks these efforts and measures intended program outcomes related to the awareness and use of public reports of physician and hospital quality.
QI efforts have expanded over the past decade to confront evidence of relatively low performance in the U.S. health system. Working under the premise that “all health care is local,” many advocates of health care reform recently have turned their attention to a community-level approach to implementing QI. The collaborative implementation of QI at the local level is central to the AF4Q theory of change, and AF4Q evaluation data provide insight into the effectiveness of this approach in creating more meaningful and sustainable improvement.
AF4Q emphasizes improvements in care for all patients, including patients from all racial and ethnic backgrounds, and 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.
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. The AF4Q Evaluation focuses on how the AF4Q communities are collecting and using data to reduce health care disparities. In addition, we 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.