The American journal of managed care
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The Aligning Forces for Quality (AF4Q) initiative is the Robert Wood Johnson Foundation's (RWJF's) signature effort to increase the overall quality of healthcare in targeted communities throughout the country. In addition to sponsoring this 16-site, complex program, the RWJF funds an independent scientific evaluation to support objective research on the initiative's effectiveness and contributions to basic knowledge in 5 core programmatic areas. The research design, data, and challenges faced in the evaluation of this 10-year initiative are discussed. ⋯ The AF4Q initiative is arguably the largest community-level healthcare improvement demonstration in the United States to date; it is being implemented at a time of rapid change in national healthcare policy. The implementation of large-scale, multi-site initiatives is becoming an increasingly common approach for addressing problems in healthcare. The evaluation research design for the AF4Q initiative, and the lessons learned from its approach, may be valuable to others tasked with evaluating similar community-based initiatives.
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To (1) measure utilization of and adherence to heart failure medications and (2) assess whether better adherence is associated with lower Medicare spending. ⋯ Higher levels of medication adherence among Medicare beneficiaries with CHF were associated with lower cumulative Medicare spending over 3 years, with savings generally exceeding the costs of the drugs in question.
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To assess the impact of clinical complexity on 3 dimensions of diabetes care. ⋯ Patients with greatest complexity received higher quality diabetes care compared with less complex patients, regardless of the definition of complexity chosen. Although providers may appropriately target complex patients for aggressive control, deficits in guideline achievement among all diabetic patients highlight the challenges of caring for chronically ill patients and the importance of structuring primary care to promote higher-quality, patient-centered care.
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To assess frequency and severity of patient safety incidents in primary care. ⋯ This study presents a supplemental approach to identification of safety threats in primary care. Many incidents occur regularly and are highly relevant for healthcare professionals' daily work.The results offer guidance on setting priorities for patient safety in primary care.