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Objective: To explore why and how health systems are engaging in care delivery redesign (CDR)-defined as the variety of tools and organizational change processes health systems use to pursue the Triple Aim. Study Setting: A purposive sample of 24 health systems across 4 states as part of the Agency for Healthcare Research and Quality's Comparative Health System Performance Initiative. Study Design: An exploratory qualitative study design to gain an 'on the ground' understanding of health systems' motivations for, and approaches to, CDR, with the goals of identifying key dimensions of CDR, and gauging the depth of change that is possible based on the particular approaches to redesign care being adopted by the health systems. Data Collection: Semi-structured telephone interviews with health system executives and physician organization leaders from 24 health systems (n = 162). Principal Findings: We identify and define 13 CDR activities and find that the health systems' efforts are varied in terms of both the combination of activities they are engaging in and the depth of innovation within each activity. Health system executives who report strong internal motivation for their CDR efforts describe more confidence in their approach to CDR than those who report strong external motivation. Health system leaders face uncertainty when implementing CDR due to a limited evidence base and because of the slower than expected pace of payment change. Conclusions: The ability to validly and reliably measure CDR activities-particularly across varying organizational contexts and markets--is currently limited but is key to better understanding CDR's impact on intended outcomes, which is important for guiding both health system decision making and policy making. KEYWORDS care delivery redesign, health care delivery, health systems, value-based care, 1 | INTRODUCTION It is hypothesized that successful health care organizations in the new paradigm of transformation will re-engineer the way health care has traditionally served patients. The goals of [...]

Objective. To determine if the release of health care report cards focused on physician practice quality measures leads to changes in consumers' awareness and use of this information. Primary Data [...]

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. Study Setting. 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. Study Design. This is a quasi-experimental, pre-post study. We used a difference-indifference approach to detect relative changes over time on 16 survey-based outcome measures representing the four patient experience domains. Data Collection. We surveyed adults with chronic illness(es) in 14 AF4Qcommunities and a national comparison group. Wave 1 was completed in 2008 (8,140 respondents) and wave 2 in 2012 (9,565 respondents). Principal Findings. 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. Key Words. Quality improvement, chronic illness, patient experience, In response to clear evidence that our health system does not perform as well as it should (Institute of Medicine [IOM] 2000; McGlynn et al. 2003; Mangione-Smith et al. 2007), [...]

Objective. The purpose of this article was to identify some common organizational features of multisector health care alliances (MHCAs) and the analytic challenges presented by those characteristics in assessing organizational change. Data Sources. Two rounds of an Internet-based survey of participants in 14 MHCAs. Study Design. We highlight three analytic challenges that can arise when quantitatively studying the organizational characteristics of MHCAs--assessing change in MHCA organization, assessment of construct reliability, and aggregation of individual responses to reflect organizational characteristics. We illustrate these issues using a leadership effectiveness scale (12 items) validated in previous research and data from 14 MHCAs participating in the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) program. Findings. High levels of instability and turnover in MHCA membership create challenges in using survey data to study changes in key organizational characteristics of MHCAs. We offer several recommendations to diagnose the source and extent of these problems. Key Words. Health care organizations and systems, organization theory, psychometrics, Multisector health care alliances (MHCAs) are voluntary organizations that bring together a diverse array of stakeholders (including physicians, hospitals, health insurers, employers, government agencies, and consumers) to work collaboratively on [...]