Continue Reading Looking back on AF4Q: Reflections on community-based quality improvement"/>

Looking back on AF4Q: Reflections on community-based quality improvement

Aligning Forces for Quality (AF4Q), the signature health transformation project of the Robert Wood Johnson Foundation (RWJF), came to a close in late 2015. This program was the largest privately-funded, community-based quality improvement initiative the country had seen to date, and over time it has given stakeholders more information than ever regarding both barriers and opportunities for improving the delivery of high-quality, cost-effective, and equitable healthcare. Those lessons are detailed this week in a special supplemental issue of The American Journal of Managed Care. Click here to read the full article and learn more about the underlying theory of change, its evolution over time, and the key activities undertaken by alliances across the country. Below we’ll explore the many ways AF4Q continues to impact health and healthcare in our own region of Greater Cincinnati and Northern Kentucky.

Cincinnati was one of only 16 communities selected back in 2008 to participate in the project. Thanks to AF4Q resources and support, The Health Collaborative was honored to help guide the region toward creating a “culture of health.” While AF4Q itself has concluded, the important transformation work it inspired still continues.

AF4Q is responsible, either directly or indirectly, for the development of some of our signature programs such as the initial Patient-Centered Medical Home (PCMH) transformation, public reporting of health outcomes on YourHealthMatters, payment reform initiatives such as Comprehensive Primary Care (CPC), and the regional Collective Impact on Health initiative, now known as Gen-H.

  • YourHealthMatters is the only public reporting website that offers consumers objective information about area healthcare providers and their services. Data provided to the website voluntarily by providers allows us to track measures of patient care and align healthcare outcome goals with patient self-management goals. Throughout the duration of the initiative, every measure reported has improved over baseline. The website measures colorectal cancer screening rates, cardiovascular health, hypertension/high blood pressure, and diabetes.
  • The “MakeTheRightCall” campaign was created by our Consumer Council as a part of AF4Q.  Using digital media, the community learned the value of saving the emergency room for real emergencies and strengthening their relationship with their primary care doctor to get treatment for urgent health issues. The campaign has been embraced and shared by the faith community, health care providers, the Council on Aging, and many other partners.
  • AF4Q was the forebear of the Gen-H (Collective Impact on Health) effort currently underway in the seven-county Greater Cincinnati region of Hamilton, Clermont, Warren, and Butler counties in Ohio; and Boone, Kenton, and Campbell counties in Kentucky. This work will result in a sustained, coordinated community agenda to improve health and health care and reduce the burden of health care costs on our community.
  • AF4Q also enabled The Health Collaborative to fulfill a need for expertise in the region with the hiring of former Procter & Gamble brand specialist and marketing manager, Judy Hirsh. As director of consumer strategy & engagement and the AF4Q program director, Hirsh convened focus groups to determine how consumers would best understand and use health care quality ratings.

In March of 2014, Cincinnati’s efforts to improve diabetes care and increase patient engagement in their own diabetes management was featured in an article in the publication Journalists on Quality. This 2014 series included insightful profiles written by prominent health policy journalists on how RWJF’s AF4Q initiative has affected care in local communities.

As noted in Geri Aston’s article “An Infusion of Resources Gets the Quality Ball Rolling,” prior to receiving the $3 million grant from AF4Q, our health improvement efforts in the Cincinnati region were “abundant but not systematic,” said Craig Brammer, CEO of The Health Collaborative. Past initiatives were plentiful but generally small and isolated, such as seasonal flu shot programs and mental health awareness campaigns. “AF4Q provided that infusion of resources, expertise, and cooperation with sister alliances to allow us to ramp up the level of our work,” Brammer said. Today, about 800 Cincinnati-area primary care practices are reporting measures on the YourHealthMatters website and more than 200 practices are certified as PCMH practices.

The outcomes and achievements noted above are encouraging, and over time, they will help transform the community in which we live, work, learn, and play by promoting and fostering a culture of health. Perhaps just as important are the relationships, trust, and community will that have been built around these programs. The Health Collaborative remains enormously grateful to the Robert Wood Johnson Foundation and Aligning Forces for Quality for their support and expertise, to the partnerships that resulted from it, and for the enduring legacy they helped create in improving Greater Cincinnati’s health landscape.

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