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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.