Qual-IT - June 2007 | Archived

In 2006, the Robert Wood Johnson Foundation launched “Aligning Forces for Quality: The Regional Market Project” to support comprehensive, coordinated, community-based approaches to improving the quality of ambulatory care for patients with chronic disease.  The project provides grant monies and technical support to selected communities to help providers improve their ability to deliver high-quality care and measure and report performance, and to help patients and other consumers understand their roles in recognizing and demanding quality care.  Underlying “Aligning Forces” is a market research study conducted and recently issued by the Foundation and the Center for Health Improvement.  The study looked at key attributes of the health care market in 14 communities across the country, and how those characteristics affect quality improvement efforts.
 
Based on themes from the Institute of Medicine report Crossing the Quality Chasm, and on input from national experts, the key attributes were:

• Community leadership;
• Community ability to support provider quality improvement;
• Performance measurement efforts;
• Public reporting of performance measures;
• Alignment of provider financial incentives with improvement;
• HIT infrastructure; and
• Consumer engagement.

Within each of these areas, evaluation criteria adapted from the Assessment of Chronic Illness Care tool, created by the MacColl Institute for Healthcare Innovation at Group Health Cooperative of Puget Sound, produced scores that translated to rankings of “optimal,” “good,” “basic,” or “limited.”  Along with quantitative assessments of conditions in each community, interviews and site visits provided additional information on stakeholder involvement and the larger community context, to identify regional strengths and challenges.

Based on their composite scores, 12 of the 14 communities assessed were ranked at the “basic” level, indicating real limitations in comprehensive, coordinated, market-level efforts to improve quality.  There was wide variation, however, in how communities scored on individual attributes.  Many demonstrated strong community leadership, with 13 of 14 ranked as “good” in this area, indicating the ability to leverage other market forces to build effective community models.  Most communities—12 of 14—also demonstrated strong performance measurement efforts, another foundational element for coordinating other strategies.  Just under half of the communities studied have taken the further step of coordinating public reporting of performance measurement activities.  By contrast, most of the communities had limited experience with respect to financial incentives, HIT infrastructure, and consumer engagement—all of which are needed to shape and sustain broad health care systems changes.

What is difficult to determine, the report points out, is “which of these seven attributes might have the greatest impact on a community’s quality of care….[T]wo identically scored communities may ultimately have very different quality outcomes….”  Does one community’s focus on HIT and financial incentives, for example, yield stronger results than another community’s emphasis on publishing and linking payments to report cards?  “While the two communities may have identical composite scores…it is unknown which of their respective investments might actually produce higher-quality care,” the report concludes.

Notwithstanding this uncertainty, no community received an optimal ranking overall or on individual attributes, so a substantial gap remains between current capabilities and the combined conditions needed for significant health care systems improvement.  What is also clear, the study report notes, is that the differences between communities’ leadership, infrastructure, and delivery of services “shape and inform…the individual’s experience receiving health care” and must be considered when planning quality improvement efforts.  Further, “there are multiple opportunities for intervention at the local level,” and critical to such interventions are public-private partnerships and public-sector support.

The study provides a framework within which communities can organize quality improvement activities, and policymakers can measure performance and evaluate gaps in community capacity.  Building the HIT infrastructure is a key element of this framework, an effort that could be supported through provider incentives and consumer engagement activities.  Aligning Forces for Quality will advance community-level efforts and, it is hoped, provide guidance for additional policy and implementation activities at the national, state, and local levels.

United Hospital Fund Conference
July 17
Quality Strategies/Quality Programs: Assessing the Landscape in New York

The Fund's Quality Strategies Initiative was launched in 2003 to identify opportunities for coordinated efforts to advance the quality agenda in New York.  Given the wide variety of activities taking place at the state and local levels, how can these disparate efforts be organized in a more purposeful way to achieve broad health care systems change?  How do we determine which strategies make a difference?  And what has been learned about defining objectives and overcoming obstacles to sustainable quality improvement?  These and other critical questions will be addressed by Quality Strategies/Quality Programs, the Fund-sponsored conference taking place on July 17.

Setting the stage for the day's presentations and discussions, Cathy Schoen, senior vice president of the Commonwealth Fund and executive research director of its Commission on a High Performance Health System, will lay out a broad agenda for quality assessment and improvement.  Such systemic improvement will require not only alignment of the factors described in the Robert Wood Johnson Foundation study but also measures such as ensuring universal health insurance coverage and developing the health care workforce essential to patient-centered primary care.  The Commission has already developed a national scorecard to assess progress on these measures, and will soon release the first state scorecard for high-performance health systems.

Beyond this broad context, the conference will also feature panels on several specific issues, including measurement and improvement of chronic care quality, collaborative efforts to advance hospital quality improvement, innovative models addressing organizational culture and professional competencies, and collaborative efforts to use HIT to improve health care quality.

Complete conference information and online registration is available at http://www.uhfnyc.org/calendar_contact3160/calendar_contact_show.htm?doc_id=484284.

Powers PE and MW Painter.  2007.  A Checkup on Health Care Markets.  Princeton, NJ: Robert Wood Johnson Foundation.  Available online at http://www.rwjf.org/files/publications/other/AF4QExecutiveSummary.pdf

Additional information on the Assessment of Chronic Illness Care survey is available online at http://www.improvingchroniccare.org/index.php?p=ACIC_Survey&s=35