Overview

A number of Robert Wood Johnson Foundation programs and research efforts have focused on improving the care provided to patients in both outpatient and inpatient settings. Establishing safer and more effective care will require better teamwork, communication and coordination among those who give care, get care and pay for care. The communities that are involved in the Aligning Forces for Quality Initiative are bringing together these stakeholders to turn promising practices into real results and improve the overall quality of U.S. health care.

History

In particular, two Foundation-sponsored programs, Improving Chronic Illness Care (ICIC) and Improving Performance in Practice (IPIP), have focused on improved care for patients with chronic illnesses in outpatient settings.

ICIC is dedicated to helping the 133-million Americans who suffer from diabetes, depression and other chronic conditions lead healthier lives. The centerpiece of ICIC's effort has been the use of the Chronic Care Model. The Chronic Care Model identifies the essential elements of a health care system that encourage high-quality chronic disease care, including the community, the health system, self-management support, delivery-system design, decision support and clinical information systems. ICIC has demonstrated that not only do improvements in these areas facilitate quality improvement, but they also reduce overall health care costs. The model can be applied to a variety of chronic illnesses, health care settings and target populations.

IPIP is a pilot program designed to put theory into practice, giving doctors and their staffs the tools, systems and support to provide consistently high-quality care and improve patient health. IPIP is helping small- and medium-sized practices to close the gap between the ideal care recommended through nationally recognized measures and the care that many patients generally receive.

Two other Foundation programs have focused on inpatient care, Expecting Success: Excellence in Cardiovascular Care and Pursuing Perfection.

Expecting Success, one of the Foundation's biggest programs to reduce disparities in health care, focused on improving the quality of cardiovascular care for racial and ethnic minority populations in the United States. Ten hospitals across the country uniformly measured the quality of care provided to patients of different racial and ethnic backgrounds and worked to implement changes to better ensure that all patients consistently received high-quality, well-coordinated care across inpatient and outpatient settings.

The Foundation's Pursuing Perfection initiative raises the bar on health care performance by placing patients at the center of the community-wide health care system and changing various patient care processes. Program elements include the creation of rapid response teams, the implementation of computerized data and tracking systems, coordinated care and increased training. Through these efforts, Pursuing Perfection sites have learned that aiming high leads to clinical and operational results once considered out of reach.

Application

The Foundation's efforts to improve health care quality will continue to include a strong focus on better ways to coordinate quality improvement services. Lessons learned and best practices from these programs and initiatives will be shared to increase knowledge and deliver lasting change across entire communities.