Aligning Forces for Quality Evaluation - Research Areas
To measure the impact of the AF4Q initiative, the AF4Q Evaluation places particular emphasis on five key areas:
“No single person, group, or profession can improve health and health care throughout a community without the support of others.”
Health care quality improvement (QI) efforts have expanded over the past decade to confront evidence of relatively low performance in the US health system. Working under the premise that “all health care is local,” many advocates of health care reform have recently 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 compelling insight into the effectiveness of this approach in creating more meaningful and sustainable improvement.
Performance Measurement and Public Reporting
“We need to measure results, make it public, and use transparency to drive improvement and engage consumers.”
-AF4Q Alliance Leader
As the health care transparency movement has evolved, AF4Q is one program that has put substantial effort into improving access to health care cost and quality information. The AF4Q Evaluation tracks these efforts and measures intended program outcomes related to the awareness and use of public reports of physician and hospital quality.
“Aligning Forces for Quality has really pushed us into new territory … around the consumer engagement activities.”
- AF4Q Alliance Leader
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 US. 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 explores the various aspects of this approach.
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.
Multistakeholder Alliance Goverance & Sustainablilty
Convening individuals and organizations from across sectors of the system to develop and implement health improvement strategies is an approach that many initiatives are currently engaged in, with the hope that multiple stakeholders can create more positive change together than any one sector could alone. AF4Q efforts to align stakeholders with differing agendas, establish agreed upon goals and strategies, and ultimately sustain alliance activities is an important aspect of the program, as well as a particular focus area for the AF4Q evaluation.