title: Evaluating a community-based program to improve healthcare quality: research design for the Aligning Forces for Quality initiative.
abstract: OBJECTIVE
  The Aligning Forces for Quality (AF4Q) initiative is the Robert Wood Johnson Foundation's (RWJF's) signature effort to increase the overall quality of healthcare in targeted communities throughout the country. In addition to sponsoring this 16-site, complex program, the RWJF funds an independent scientific evaluation to support objective research on the initiative's effectiveness and contributions to basic knowledge in 5 core programmatic areas. The research design, data, and challenges faced in the evaluation of this 10-year initiative are discussed.
  
  
  METHODS
  A descriptive overview of the evaluation research design for a multi-site, community based, healthcare quality improvement initiative is provided.
  
  
  METHODS
  The multiphase research design employed by the evaluation team is discussed.
  
  
  RESULTS
  Evaluation provides formative feedback to the RWJF, participants, and other interested audiences in real time; develops approaches to assess innovative and under-studied interventions; furthers the analysis and understanding of effective community-based collaborative work in healthcare; and helps to differentiate the various facilitators, barriers, and contextual dimensions that affect the implementation and outcomes of community-based health interventions.
  
  
  CONCLUSIONS
  The AF4Q initiative is arguably the largest community-level healthcare improvement demonstration in the United States to date; it is being implemented at a time of rapid change in national healthcare policy. The implementation of large-scale, multi-site initiatives is becoming an increasingly common approach for addressing problems in healthcare. The evaluation research design for the AF4Q initiative, and the lessons learned from its approach, may be valuable to others tasked with evaluating similar community-based initiatives.
authors.affiliation: Department of Health Policy and Administration, Penn State University, University Park, PA 16802, USA. dpscanlon@psu.edu
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Scanlon
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Alexander
authors.forename: Jeff
authors.initials: J
authors.lastname: Beich
authors.forename: Jon B
authors.initials: JB
authors.lastname: Christianson
authors.forename: Romana
authors.initials: R
authors.lastname: Hasnain-Wynia
authors.forename: Megan C
authors.initials: MC
authors.lastname: McHugh
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Mittler
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Shi
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Bodenschatz
mesh_terms: D003153:Community Health Services / Q000458:organization & administration* / Q000592:standards; D003256:Community Participation; D005582:Foundations; D006302:Health Services Research; D006801:Humans; D015397:Program Evaluation / Q000379:methods*; D058996:Quality Improvement / Q000458:organization & administration*; D012107:Research Design