title: Community-Level Quality Improvement and the Patient Experience for Chronic Illness Care.
abstract: OBJECTIVE
  To determine whether chronically ill adults from communities participating in a community-level quality improvement effort reported greater improvement on four domains of patient experience: care coordination, patient satisfaction, provider interaction and support, and receipt of recommended care for diabetes.
  
  
  METHODS
  The Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) initiative provides multistakeholder alliances with funding and technical assistance to improve quality in their communities.
  
  
  METHODS
  This is a quasi-experimental, pre-post study. We used a difference-in-difference approach to detect relative changes over time on 16 survey-based outcome measures representing the four patient experience domains.
  
  
  METHODS
  We surveyed adults with chronic illness(es) in 14 AF4Q communities and a national comparison group. Wave 1 was completed in 2008 (8,140 respondents) and wave 2 in 2012 (9,565 respondents).
  
  
  RESULTS
  Respondents from AF4Q communities reported modestly greater improvement on patient satisfaction and receipt of recommended care for diabetes.
  
  
  CONCLUSIONS
  Results suggest that community-level QI efforts led by multistakeholder alliances hold the potential to improve patient satisfaction and receipt of recommended care for diabetes, but the magnitude of the effect may be limited. However, there is less evidence that community-level QI can improve patient perceptions of care coordination or provider interaction and support.
authors.affiliation: Center for Healthcare Studies and Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Megan
authors.initials: M
authors.lastname: McHugh
authors.affiliation: Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC.
authors.forename: Jillian B
authors.initials: JB
authors.lastname: Harvey
authors.affiliation: Center for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, IL.
authors.forename: Raymond
authors.initials: R
authors.lastname: Kang
authors.affiliation: Department of Health Policy and Administration, Center for Health Care Policy and Research, The Pennsylvania State University, University Park, PA.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Department of Health Policy and Administration, Center for Health Care Policy and Research, The Pennsylvania State University, University Park, PA.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Scanlon
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003153:Community Health Services / Q000458:organization & administration* / Q000592:standards; D003266:Continuity of Patient Care / Q000458:organization & administration; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D015438:Health Behavior; D006302:Health Services Research; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D058996:Quality Improvement / Q000458:organization & administration*; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Quality improvement; chronic illness; patient experience