title: The longitudinal impact of Aligning Forces for Quality on measures of population health, quality and experience of care, and cost of care.
abstract: OBJECTIVE
  To summarize the results from the quantitative analyses conducted during the summative evaluation of the Aligning Forces for Quality (AF4Q) initiative.
  
  
  METHODS
  Longitudinal design using linear difference-in-difference (DD) regression models with fixed effects. Outcomes were selected based on the AF4Q program logic model and organized according to the categories of the Triple Aim: improving population health, improving quality and experience of care, and reducing the cost of care.
  
  
  METHODS
  Two primary data sources: the AF4Q Consumer Survey and the National Study of Physician Organizations (NSPO); and 4 secondary data sources: the Dartmouth Atlas Medicare claims database, the Truven Health MarketScan commercial claims database, the Behavioral Risk Factor Surveillance System (BRFSS), and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS).
  
  
  RESULTS
  In total, 144 outcomes were analyzed, 27 were associated with improving population health, 87 were associated with improving care quality and experience, and 30 were associated with reducing the cost of care. Based on the estimated DD coefficients, there is no consistent evidence that AF4Q regions, over the life of the program, showed greater improvement in these measures compared with the rest of the United States. For less than 12% of outcomes (17/144), the AF4Q initiative was associated with a significant positive impact (P ≤.05), although the magnitude of the impact was often small. Among the remaining outcomes, with some exceptions, similarly improving trends were observed in both AF4Q and non-AF4Q areas over the period of intervention. Conclusion and Policy and Practice Implications: Our quantitative findings, which suggest that the AF4Q initiative had less impact than expected, are potentially due to the numerous other efforts to improve healthcare across the United States, including regions outside the AF4Q program over the same period of time. The limited overall impact may also be due to the variability in the "dose" of the interventions across AF4Q regions. However, these results should not be interpreted as a conclusive statement about the AF4Q initiative. More nuanced discussions of the implementation of interventions in the specific AF4Q programmatic areas and their potential success (or lack thereof) in the participating communities are included in other articles in this supplement.
authors: yus16@psu.edu.
authors: Yunfeng
authors: Y
authors: Shi
authors: Dennis P
authors: DP
authors: Scanlon
authors: Raymond
authors: R
authors: Kang
authors: Megan
authors: M
authors: McHugh
authors: Jessica
authors: J
authors: Greene
authors: Jon B
authors: JB
authors: Christianson
authors: Muriel
authors: M
authors: Jean-Jacques
authors: Yasmin
authors: Y
authors: Mahmud
authors: Jeffrey A
authors: JA
authors: Alexander
mesh_terms: D003153:Community Health Services / Q000191:economics* / Q000592:standards*; D005582:Foundations / Q000458:organization & administration; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008329:Managed Care Programs / Q000191:economics / Q000592:standards*; D009937:Organizational Objectives; D011159:Population Surveillance; D058996:Quality Improvement / Q000191:economics* / Q000592:standards*; D011787:Quality of Health Care / Q000191:economics* / Q000592:standards*; D014481:United States