School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Am J Manag Care. 2012 Sep;18(6 Suppl):s115-25.
The Robert Wood Johnson Foundation's (RWJF's) Aligning Forces for Quality (AF4Q) initiative is the largest privately funded community-based quality improvement initiative to date, providing funds and technical assistance (TA) to 16 multi-stakeholder alliances located throughout the United States. The objectives of this article are to describe the AF4Q initiative's underlying theory of change, its evolution over time, and the key activities undertaken by alliances.
This is a descriptive overview of a major multi-site, community-based quality improvement initiative.
A qualitative approach was used with information obtained from program documents, program meetings, observation of alliance activities, and interviews with RWJF staff, TA providers, and AF4Q alliance stakeholders.
AF4Q is a dynamic initiative, expanding and evolving over time. Participating alliances are addressing 5 main programmatic areas: (1) measurement and public reporting of healthcare quality and efficiency for ambulatory physician practices and hospitals; (2) efforts to engage consumers as partners in their own care (consumer engagement); (3) adoption and spread of effective quality improvement strategies to improve care; (4) ensuring the equitable receipt of healthcare; and (5) integration of alliance activities with payment reform initiatives.
The AF4Q initiative is an ambitious program affecting multiple leverage points in the healthcare system. AF4Q alliances were provided a similar set of expectations and given access to substantial TA. While participating alliances have made progress in addressing the AF4Q programmatic areas, given differences in the alliances' composition, market structure, and history, there is considerable variation in program implementation.
罗伯特·伍德·约翰逊基金会（RWJF）的“合力改善质量”（AF4Q）倡议是迄今为止最大的私人资助的以社区为基础的质量改进倡议，为美国各地的 16 个多利益相关者联盟提供资金和技术援助（TA）。本文的目的是描述 AF4Q 倡议的变革理论、随时间的演变以及联盟所采取的关键活动。
这是对一个主要的多地点、以社区为基础的质量改进倡议的描述性概述。
采用定性方法，从项目文件、项目会议、联盟活动观察以及对 RWJF 工作人员、TA 提供者和 AF4Q 联盟利益相关者的采访中获取信息。
AF4Q 是一个充满活力的倡议，随着时间的推移不断扩展和演变。参与的联盟正在解决 5 个主要的项目领域：（1）测量和公布门诊医生实践和医院的医疗保健质量和效率；（2）努力让消费者作为其自身护理的合作伙伴参与进来（消费者参与）；（3）采用和传播有效的质量改进策略以改善护理；（4）确保公平获得医疗保健；以及（5）将联盟活动与支付改革倡议整合。
AF4Q 倡议是一个雄心勃勃的项目，影响医疗保健系统的多个杠杆点。AF4Q 联盟获得了一套类似的期望，并获得了大量的 TA。虽然参与的联盟在解决 AF4Q 项目领域方面取得了进展，但鉴于联盟的组成、市场结构和历史的差异，在项目实施方面存在相当大的差异。
