Summative evaluation results and lessons learned from the Aligning Forces for Quality program.

Area of Science:

• Healthcare quality improvement
• Public health initiatives
• Health services research

Background:

• The Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) initiative aimed to improve healthcare quality across communities nationwide.
• This program ran from 2005 to 2015, supporting 16 grantee alliances in implementing interventions across five key areas.

Purpose of the Study:

• To evaluate the summative results of the AF4Q initiative.
• To assess the impact of AF4Q interventions on community health and healthcare quality outcomes.
• To identify factors influencing program success and sustainability.

Main Methods:

• A longitudinal, mixed-methods program evaluation was conducted.
• 16 nonexperimentally selected grantee alliances across the US participated.
• Data were collected on quantitative outcomes related to the Triple Aim and qualitative aspects of intervention implementation and sustainability.

Main Results:

• No significant differences in longitudinal improvement rates were observed between AF4Q and control communities for most Triple Aim outcomes.
• Improvements were noted in both groups, with some exceptions in cost of care and population health.
• Significant heterogeneity existed in intervention scope and scale; no alliance fully implemented all five programmatic areas. Stakeholder engagement was initially successful but long-term sustainability and funding were challenging.

Conclusions:

• The AF4Q initiative did not achieve its overarching goals for community-level change but yielded localized successes.
• Variations in program impact were linked to differing acceptance of the initiative's theory of change, grantee capacity, local market contexts, and evolving program requirements.
• Lessons learned from AF4Q offer valuable insights for future regional health improvement efforts.