Aligning Forces for Quality Evaluation Updates

Patient-Centered Medical Home Adoption: Results From Aligning Forces For Quality

Authors: Megan McHugh, Yunfeng Shi, Patricia P. Ramsay, Jillian B. Harvey, Lawrence P. Casalino, Stephen M. Shortell, and Jeffrey A. Alexander

With its signature effort, Aligning Forces for Quality (AF4Q), the Robert Wood Johnson Foundation (RWJF) employed a unique model to lift the overall quality of care in 16 communities across the country. Between 2006 and 2015, RWJF provided unprecedented funding and technical assistance to multi-stakeholder alliances (payers, purchasers, providers, and consumers) that voluntarily collaborate to address local health goals. A common goal among the alliances was to motivate physician practices to improve the delivery of primary care, specifically by adopting patient-centered medical home (PCMH) processes. This study relied on data from two rounds of a large nationally representative survey of small and medium-size physician practices (July 2007-March 2009 and January 2012-November 2013) to examine whether PCMH adoption spread more rapidly in AF4Q communities vs. other communities. While there was no difference in the overall growth of adoption of PCMH processes between the two types of communities, we did see slightly higher improvement in care coordination in AF4Q communities.

Our findings still should be of interest to policy makers, payers, purchasers, and other organizations that have encouraged the adoption of PCMH processes. Even though multi-stakeholder alliances may not be the panacea for spreading these processes to small and medium-size physician practices across a community, targeting specific quality improvement domains, such as care coordination, may be a promising endeavor.

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21st Annual International Scientific Symposium on Improving the Quality and Value of Health Care

December 7, 2015

In conjunction with

27th Annual National Forum on Quality Improvement in Health Care
Orlando, Florida

Dr. Dennis Scanlon and Dr. Jillian HarveyPresentations:

The Impact of Multi-stakeholder Approaches to Improving Care Delivery: A Systematic Review
Presenter: Jillian Harvey, Assistant Professor, Medical University of South Carolina

The Influence of Local Context on Multi-stakeholder Alliance Quality Improvement Activities: A Multiple Case Study
Presenter: Jillian harvey, Assistant Professor, Medical University of South Carolina

Measuring the Dose of Quality Improvement Interventions
Presenter: Jillian Harvey, Assistant Professor, Medical University of South Carolina (MUSC)

A Systematic Review of the Literature on the Sustainability of Community Health Collaboratives

Quality improvement increasingly has taken center stage in national health care policy debates, but many argue that improving quality and efficiency ultimately depends on the commitment and actions of key stakeholders at the local level. Additionally, some hypothesize that the potential for better outcomes exists when improvement efforts are aligned and coordinated among members of a community health collaborative, rather than executed independently by health plan, purchaser, provider, or consumer groups.

There are, however, a number of challenges to sustaining the activities of collaboratives; for example, besides the continual need for funding, leaders must recruit diverse, sometimes even disparate members, and work within their competing interests. Some partners may become “free riders’ – receiving membership benefits without contributing resources. And still others may lack long-term commitment because barriers to exit generally are low. Therefore, many believe that to realize their ambitious goals and demonstrate meaningful impact, community health collaboratives must develop the capacity to sustain both activity and participation over a significant period of time.

To help guide future research, planning, and practice of sustainable community health collaboratives, the authors developed a synthesized definition, conceptual groups of antecedents, and potential research propositions based on their systematic review of the theoretical and empirical literature on health care collaborative sustainability. This review was part of a larger evaluation of the Robert Wood Johnson Foundation’s (RWJF) Aligning Forces for Quality (AF4Q) initiative.

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Who’s Aware of and Using Public Reports of Provider Quality?

Over the last decade there has been a substantial increase in public reporting of health care provider quality performance. While this transparency strategy began as a way to accelerate quality improvement among providers, more recently the public reporting of comparative quality information (CQI) has been intended to foster informed decision-making among consumers. Many authors have expressed concern that CQI might exacerbate racial/ethnic and income-based disparities. This paper examines which consumers are aware of and using CQI.

Using data from the second wave of the Robert Wood Johnson Foundation’s Aligning Forces for Quality (AF4Q) evaluation consumer survey (2011/2012), finds that the vast majority of consumer have yet to embrace using information comparing physician and hospital quality performance. Only 8% of adults with chronic conditions reported using hospital quality reports and 6% physician reports.

Findings related to CQI and disparities were mixed. While higher income and better educated consumers were more likely to be aware of CQI than less affluent or educated respondents, the magnitude of difference between subgroups was small. Contrary to expectations, African Americans and Latinos were slightly more likely to be aware of and use CQI than whites, but again the differences were small in magnitude. In sum, provision of CQI has not yet translated to widespread use of CQI, and minorities along with more affluent and educated consumers are slightly more likely to be aware of and using CQI.

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Effective presentation of health care performance information for consumer decision making: A systematic review

Understanding effective ways to present comparative health information is increasingly important as consumers are expected to “vote with their feet” and select high quality and high value health care providers. This article systematically reviewed experimental studies published over the last decade that compared consumers’ responses to comparative performance information when one or more presentation feature was altered.

The 31 articles consistently found that consumers better understood and made more informed choices when information displays were less complex. Notably, consumers made higher quality choices when there was less information presented- including when there were fewer options to choose between and when there were fewer attributes to compare the options on. The studies also found that categorizing and translating performance results for consumers, by using approaches such as star ratings and word icons, were more effective than presentation approaches that relied on consumers to make sense of the information themselves (e.g. percentages). The review highlights the importance of testing displays of comparative health information aimed at consumers, since presentation approach can substantially influence how well consumers make sense of the information.

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Measuring the Dose of Quality Improvement Initiatives

In this unique exploratory article, the authors: (a) examined the literature on intervention dose — defined as the quality and quantity of an intervention and participation; (b) identified four methods for measuring quality improvement (QI) dose; and (c) applied those methods across14 communities participating in the Robert Wood Johnson Foundation’s signature QI initiative, Aligning Forces for Quality (AF4Q). Although dose may be key to understanding why some multisite QI initiatives work and others do not, evaluations rarely consider dose, further there is no widely accepted method for measuring it. Among the first of its kind, this study considers multiple ways to measure QI dose, including the accompanying challenges, and demonstrates that how one constructs and applies measures of dose can have important implications for research findings. The authors also offer suggestions for advancing the field in measuring QI dose as they ultimately seek to bring the field closer to the development of a robust measure, which would provide practical, actionable information for evaluators and organizations seeking to adopt QI interventions.

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Approaches to Reducing Health Care Disparities: A Focus on Six Multi-Stakeholder Alliances

Reducing racial and ethnic disparities in health care was one of the key objectives of the AF4Q initiative.This research summary highlights the major activities aimed at reducing disparities in care implemented across six AF4Q communities. Drawing upon multiple data sources from 2010-2013, we review common approaches to tackling health care disparities and call attention to a few less common, but notable approaches. The strategies undertaken by these AF4Q alliances may serve as models for other communities.

Click here to read this research summary.