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

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The Aligning Forces for Quality (AF4Q) initiative showed limited community-level improvements in healthcare quality compared to control groups. While some alliances achieved success, the program did not meet all its ambitious goals.

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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.