Aligning Forces for Quality Evaluation Updates

Recent & Upcoming Events | Recent Publications

Public Reporting and the Evolution of Diabetes Quality

The public reporting of physician quality data over time offers consumers the opportunity to assess the longitudinal stability of provider rankings based on quality of care measures as well as the improvement in quality of care for specific providers and in comparison with others. Through data submitted to Minnesota Community Measurement (MNCM), an Aligning Forces for Quality (AF4Q) community health alliance, this paper examines the quality of diabetes care provided by clinics in Minnesota from 2007-2012. In a voluntary reporting environment, such as existed in Minnesota during this period, the results suggest that consumers can reasonably infer that non-reporting clinics have lower quality care than reporting clinics. Over time, however, the analysis finds that quality improves both in early and late reporting clinics. Clinic quality is relatively persistent year-to-year, suggesting that public reports can inform consumers’ clinic choices, even though the data may not be current. The paper also points out that definition changes in quality measures can make it more difficult for consumers to draw appropriate conclusions from longitudinal public reports data.

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AF4Q Evaluation Study Finds Gradual Increase in Patient Awareness of Health Care Report Cards

The Robert Wood Johnson Foundation, the federal government, and other stakeholders have invested significantly in making comparative health care quality information available to the public and giving community members the tools needed to make effective choices about their health care. In this study we examine public awareness of these comparative quality reports and the relationship between awareness and the change in availability of comparative health care quality information. Overall, we found about 25% of the chronically ill population was aware of hospital quality reports with no change between 2007 and 2012. For physician quality reports we found a change in awareness from about 13% of the chronically ill population in 2007 to about 17% in 2012. We also found a significant variation in awareness across the 14 communities and national sample we examined and we report these results as well.

Click here to view a press release about this article

Publication Title: Are Health Care Quality “Report Cards” Reaching Consumers? Awareness in the Chronically Ill Population
Appearing In: The American Journal of Managed Care (click here to view this article online ahead of print)
Authors: Dennis Scanlon, Yunfeng Shi, Neeraj Bhandari, and Jon Christianson

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Recent & Upcoming Events

Aligning Forces for Quality Evaluation Presentations:

Using Multi-stakeholder Alliances to Reduce Hospital Readmissions: Preliminary Findings from an Evaluation of Aligning Forces For Quality (AF4Q)

Presenter: Philethea Duckett (Northwestern University)

Session/Time: Information Coming Soon

Reducing hospital readmissions is a national priority. There’s a growing appreciation that significant reductions in readmissions cannot be achieved by a single organization working in isolation. To that end, the Aligning Forces for Quality (AF4Q) initiative provides multi-stakeholder alliances– groups of payers, purchasers, providers and consumers that work together– with funding and technical assistance to improve care community-wide. Alliances were permitted to craft their own local approaches to key problems, tailored to address the communities’ unique needs and take advantage of local resources. Several alliance-led interventions were developed to reduce hospital readmissions. Our objective was to determine whether hospital readmission rates declined more in AF4Q communities compared to non-AF4Q communities by 2012, year 7 of the 10-year AF4Q initiative.

Health System Membership and Diabetes Care Performance of Ambulatory Clinics

Presenter: Daniel Crespin (University of Minnesota)

Session/Time: Evaluating and Integrating New Types of Healthcare Organizations and Practices at 9:45 AM on Tuesday, June 16, 2015.

Integrated health systems are expanding through physician practice acquisition and employment. As health systems grow, they face the challenge of delivering high-quality care across all their locations. We addressed this issue with the following three questions: 1) do health systems provide similar quality care across clinic locations, 2) do clinics in larger health systems have better performance compared to clinics in smaller systems, and 3) does the quality of acquired clinics improve post-acquisition?

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Designing Meaningful Evaluations of Complex Health Care Improvement Initiatives

On November 13th, Dennis Scanlon led a breakfast session highlighting the challenges and successes of evaluating Aligning Forces for Quality (AF4Q). The session was a part of ALIGN, a summit to discuss what’s working—and what’s needed—to improve health care quality and reduce costs in U.S. communities.

Scanlon introduced the key aspects of the AF4Q evaluation design and discussed some of its challenges and successes. Panelists (Marsha Gold of Mathematica, Mike Furukawa of the Agency for Healthcare Research & Quality, and Rob Lott of Health Affairs) reflected on the AF4Q evaluation as well as their own approaches to complex program evaluations, and discussed how evaluations can be designed in meaningful ways to enhance the utilization of evaluation findings. A Health Affairs panelist shared insights on what they look for when reporting on evaluations of large-scale health care improvement efforts like these.

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Recent Publications

Public Reporting and the Evolution of Diabetes Quality

The public reporting of physician quality data over time offers consumers the opportunity to assess the longitudinal stability of provider rankings based on quality of care measures as well as the improvement in quality of care for specific providers and in comparison with others. Through data submitted to Minnesota Community Measurement (MNCM), an Aligning Forces for Quality (AF4Q) community health alliance, this paper examines the quality of diabetes care provided by clinics in Minnesota from 2007-2012. In a voluntary reporting environment, such as existed in Minnesota during this period, the results suggest that consumers can reasonably infer that non-reporting clinics have lower quality care than reporting clinics. Over time, however, the analysis finds that quality improves both in early and late reporting clinics. Clinic quality is relatively persistent year-to-year, suggesting that public reports can inform consumers’ clinic choices, even though the data may not be current. The paper also points out that definition changes in quality measures can make it more difficult for consumers to draw appropriate conclusions from longitudinal public reports data.

Leader Perceptions of Multi-Sectoral Healthcare Alliance Response to Health Reforms

The passage of the Patent Protection and Affordable Care Act (PPACA) is a significant political event that spurred many differing expectations within the multiple sectors of the US health care system. As multi-sector health alliances work to address health-related issues through collaborative efforts, health alliance leaders play a pivotal role in organizing and interpreting political changes, like that of the PPACA, to provide guidance in their communities.

This study examines multi-sector health alliance leader’s responses to the PPACA and whether these responses differed as a function of two different political environments – states supportive of health reform and states unsupportive of health reform. The findings are of relevance to policy makers and researchers interested in understanding the interactions between government regulation and organizational response, as well as advocates, sponsors, and leaders of multi-sectoral efforts concerned with identifying threats to and ways to foster more effective collaboration.

To read more see this article online here.

Taking the Long View
How Well Do Patient Activation Scores Predict Outcomes Four Years Later?

Patient activation, or the degree to which patients have the knowledge, skill and confidence to manage their own health and healthcare, has been increasingly recognized as an important predictor of health outcomes. To inform the growing investments in activities and interventions that support increased patient activation, this study looks at changes in the level of patient activation over the course of four years in a nation-wide sample of individuals with chronic illness, and examines whether these changes are associated with change in health outcomes. Our findings do suggest that higher patient activation levels are associated with improved outcomes for a long period of time. These findings are important as health care delivery systems and health care payers seek approaches that will both improve health outcomes and reduce costs. The results, suggest that increasing patient activation may help achieve these ends.

To read more see this article online here.

What Is the Cost of Quality for Diabetes Care?

Initiatives working to increase health care quality and reduce cost often base their strategies on the notion that high quality preventive care combined with effective patient self-management leads to better clinical outcomes and lower costs. This study advances our understanding of this premise by looking at the relationship between cost and quality specifically for diabetes care.

To read more see this article online here.

Assessing Organizational Change in Multisector Community Health Alliances

Many policy makers and practitioners are interested in research that examines the use of multisector health alliances to improve the system of care; however, this is a challenging area of study due to the dynamic nature of multisector organizations. In this article, AF4Q Evaluation team members describe three analytic challenges that can arise when quantitatively studying the organizational characteristics of multisector health alliances: 1) assessing change in MHCA organization; 2) assessment of construct reliability, and 3) aggregation of individual responses to reflect organizational characteristics. Additionally, the authors propose a problem specific set of diagnostic and analytic approaches that may enable researchers to identify alternative explanations for observed findings, or account for limitations in the use of traditional methods when it comes to evaluating multisector health alliances. These findings may be of particular value to funders and program implementers interested in assessing and improving the functionality of collaborative organizations.

To read more, find this article online here.

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.