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Supplements The Aligning Forces for Quality Initiative: Early Lessons From Efforts to Improve Healthcare Quality
Creating and Sustaining Change: Early Insights From Aligning Forces
Claire B. Gibbons, PhD, MPH; and Anne F. Weiss, MPP
Getting the Structure Right for Communitywide Healthcare Improvement
Gordon Mosser, MD
Lessons for Reducing Disparities in Regional Quality Improvement Efforts
Scott C. Cook, PhD; Anna P. Goddu, MSc; Amanda R. Clarke, MPH; Robert S. Nocon, MHS; Kevin W. McCullough, MJ; and Marshall H. Chin, MD, MPH
The Imperative to Promote Collaborative Consumer Engagement: Lessons From the Aligning Forces for Quality Initiative
Debra L. Ness, MS
That Was Then, This Is Now
Lisa A. Simpson, MB, BCh, MPH, FAAP
Regional Health Improvement Collaboratives Needed Now More Than Ever: Program Directors' Perspectives
Randall D. Cebul, MD; Susanne E. Dade, MPA; Lisa M. Letourneau, MD, MPH; and Alan Glaseroff, MD, ABFM
The Aligning Forces for Quality Initiative: Background and Evolution From 2005 to 2012
Dennis P. Scanlon, PhD; Jeff Beich, PhD; Jeffrey A. Alexander, PhD; Jon B. Christianson, PhD; Romana Hasnain-Wynia, PhD; Megan C. McHugh, PhD; and Jessica N. Mittler, PhD
Barriers and Strategies to Align Stakeholders in Healthcare Alliances
Larry R. Hearld, PhD; Jeffrey A. Alexander, PhD; Jeff Beich, PhD; Jessica N. Mittler, PhD; and Jennifer L. O’Hora, BA
The Aligning Forces for Quality Initiative: Background and Evolution From 2005 to 2012 - eAppendix
Midterm Observations and Recommendations From the Evaluation of the AF4Q Initiative
Jeffrey A. Alexander, PhD; Dennis P. Scanlon, PhD; Megan C. McHugh, PhD; Jon B. Christianson, PhD; Jessica N. Mittler, PhD; Romana Hasnain-Wynia, PhD; and Jeff Beich, PhD
Producing Public Reports of Physician Quality at the Community Level: The Aligning Forces for Quality Initiative Experience
Jon B. Christianson, PhD; Karen M. Volmar, JD, MPH; Bethany W. Shaw, MHA; and Dennis P. Scanlon, PhD
Currently Reading
Community-Level Interventions to Collect Race/Ethnicity and Language Data to Reduce Disparities
Romana Hasnain-Wynia, PhD; Deidre M. Weber, BA; Julie C. Yonek, MPH; Javiera Pumarino, BA; and Jessica N. Mittler, PhD
Evaluating a Community-Based Program to Improve Healthcare Quality: Research Design for the Aligning Forces for Quality Initiative
Dennis P. Scanlon, PhD; Jeffrey A. Alexander, PhD; Jeff Beich, PhD; Jon B. Christianson, PhD; Romana Hasnain-Wynia, PhD; Megan C. McHugh, PhD; Jessica N. Mittler, PhD; Yunfeng Shi, PhD; and Laura J. B
Using Websites to Engage Consumers in Managing Their Health and Healthcare
Jessica N. Mittler, PhD; Karen M. Volmar, JD, MPH; Bethany W. Shaw, MHA; Jon B. Christianson, PhD; and Dennis P. Scanlon, PhD
Participating Faculty: The Aligning Forces for Quality Initiative: Early Lessons From Efforts to Improve Healthcare Quality at the Community Level
Letter From the Guest Editor
David Blumenthal, MD, MPP
Samuel O. Thier Professor of Medicine and Professor of Health Care Policy Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School, Boston

Community-Level Interventions to Collect Race/Ethnicity and Language Data to Reduce Disparities

Romana Hasnain-Wynia, PhD; Deidre M. Weber, BA; Julie C. Yonek, MPH; Javiera Pumarino, BA; and Jessica N. Mittler, PhD
Second, alliances have faced barriers similar to those encountered by individual organizations. Ultimately, collection of REL data needs to occur in discrete facilities, even when the push may be to collect these data at the community level. It remains difficult for any one hospital or physician practice to see the value of these REL data for their particular organization. Most AF4Q alliances have been focused on facilitating the collection of REL data by individual providers at the facility level, with the implied goal of later aggregating these data at the community level. However, this strategy may not be optimal. A more promising strategy might be to focus on building community cohesion by explicitly stating at the outset that the goal is to aggregate data across provider entities in the community, with the added benefit of individual organizations being able to use their data to implement organization-specific initiatives.

Finally, leveraging federal initiatives holds promise. The Health Information Technology for Economic and Clinical Health Act of 2009 was identified as a facilitator by a number of the AF4Q interviewees. Under the Act, hospitals and physician practices receive incentive payments if they adopt electronic health record systems that are used to collect REL data. Many of the key informants hoped that this would lend more credibility and momentum to the AF4Q alliance work in data collection. Of course, collecting these data in electronic health records is only one step toward using the data to reduce disparities in care.22

National experts and others have identified that there is a critical need for a multifaceted plan of action to reduce disparities in care. This plan needs to incorporate obtaining the support of organizational leadership, developing incentives to address disparities, and generating awareness across key players. As King et al suggest, “Ultimately, the challenge lies not only in developing the strategies that would eliminate disparities, but also in the difficult and often time-consuming process of persuading healthcare organizations across the country to adopt these strategies.”23 The AF4Q alliances have certainly begun an important local dialogue about what is needed to reduce disparities in care and, despite challenges, many AF4Q communities are on the path of being able to detect disparities in care as a first step. However, the ultimate goal is to reduce disparities at the local level, which will be the long-term measure of success.

Author affiliations: Center for Healthcare Equity and Institute for Healthcare Studies, Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL (RH-W); Center for Healthcare Equity, Institute for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, IL (RH-W, JP, DMW, JCY); Department of Health Policy and Administration, Penn State University,
University Park, PA (JNM).
Funding source: This supplement was supported by the Robert Wood Johnson Foundation (RWJF). The Aligning Forces for Quality evaluation is funded by a grant from the RWJF.
Author disclosures: Dr Hasnain-Wynia, Dr Mittler, Ms Pumarino, Ms Weber, and Ms Yonek report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Authorship information: Concept and design (RH-W, JP, DMW); acquisition of data (RH-W, JNM, DMW, JCY); analysis and interpretation of data (RH-W, JP, DMW, JCY); drafting of the manuscript (RH-W, JP); critical revision of the manuscript for important intellectual content (RH-W, JNM, DMW, JCY); obtaining funding (RH-W); administrative, technical, or logistic support (RH-W, DMW); and supervision (RH-W).
Address correspondence to: Romana Hasnain-Wynia, PhD, 750 N Lake Shore Dr, 10th Floor, Chicago, IL 60611. E-mail: r-hasnainwynia@northwestern.edu.

 

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