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Despite growing investment in producing and releasing comparative provider quality information (CQI), consumer use of CQI has remained poor. We offer a framework to interpret and synthesize the existing literature's diverse approaches to explaining the CQI's low appeal for consumers. Our framework cautions CQI stakeholders against forming unrealistic expectations of pervasive consumer use and suggests that they focus their efforts more narrowly on consumers who may find CQI more salient for choosing providers. We review the consumer impact of stakeholder efforts to apply the burgeoning knowledge of consumers' cognitive limitations to the design and dissemination of the new generation of report cards; we conclude that while it is too limited to draw firm conclusions, early evidence suggests consumers are responding to the novel design and dissemination strategies. We find that consumers continue to have difficulty accessing reliable report cards, while the media remains underused in the dissemination of report cards. [ABSTRACT FROM AUTHOR]

Purpose: Multisector health care alliances (alliances) are increasingly viewed as playing an important role in improving the health and health care of local populations, in part by disseminating innovative practices, yet alliances face a number of challenges to disseminating these practices beyond a limited set of initial participants. The purpose of this paper is to examine how alliances attempt to disseminate innovative practices and the facilitating and inhibiting factors that alliances confront when trying to do so.Design/methodology/approach: The authors adopted multiple holistic case study design of eight alliances with a maximum variation case selection strategy to reflect a range of structural and geographic characteristics. Semi-structured interviews with staff, leaders and board members were used.Findings: The findings show that dissemination is a multidirectional process that is closely if not inextricably intertwined with capacity- and context-related factors (of the alliance, partnering organizations and target organizations). Thus, standardized approaches to dissemination are likely the exception and not the rule, and highlight the value of existing frameworks as a starting point for conceptualizing the important aspects of dissemination, but they are incomplete in their description of the "on-the-ground" dissemination processes that occur in the context of collaborative organizational forms such as alliances.Originality/value: Despite a rapidly expanding evidence base to guide clinical and managerial decision making, this knowledge often fails to make its way into routine practice. Consequently, the search for effective strategies to reduce this gap has accelerated in the past decade. This study sheds light on those strategies and the challenges to implementing them. [ABSTRACT FROM AUTHOR]

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 Sources: Data from two rounds of a survey of the chronically ill adult population conducted in 14 regions across the United States, combined with longitudinal information from a public reporting tracking database. Both data were collected as part of the evaluation for Aligning Forces for Quality, a nationwide quality improvement initiative funded by the Robert Wood Johnson Foundation.Study Design: Using a longitudinal design and an individual-level fixed effects modeling approach, we estimated the impact of community public reporting efforts, measured by the availability and applicability of physician quality reports, on consumers' awareness and use of physician quality information (PQI).Principal Findings: The baseline level of awareness was 12.6 percent in our study sample, drawn from the general population of chronically ill adults. Among those who were not aware of PQI at the baseline, when PQI became available in their communities for the first time, along with quality measures that are applicable to their specific chronic conditions, the likelihood of PQI awareness increased by 3.8 percentage points. For the same group, we also find similar increases in the uses of PQI linked to newly available physician report cards, although the magnitudes are smaller, between 2 and 3 percentage points.Conclusions: Specific contents of physician report cards can be an important factor in consumers' awareness and use of PQI. Policies to improve awareness and use of PQI may consider how to customize quality report cards and target specific groups of consumers in dissemination. [ABSTRACT FROM AUTHOR]

Although intervention dose-defined as the quality and quantity of an intervention and participation-might be key to understanding why some multisite quality improvement (QI) initiatives work and others do not, evaluations rarely consider dose, and there is no widely accepted method for measuring it. In this exploratory study, the authors examined the literature on QI dose, identified four methods for measuring QI dose, applied them to 14 communities participating in a QI initiative, examined whether the dose scores aligned with perceptions of QI dose among individuals knowledgeable of the initiative, and report on lessons learned. They conclude it is feasible to measure QI dose and found a high level of concordance between scores on a comprehensive dose measure and knowledgeable informants' perceptions. However, measuring QI dose presents many challenges, including subjective decisions about the elements of dose to include in a measure and the need for extensive data collection. [ABSTRACT FROM AUTHOR]

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-in-difference 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 AF4Q communities 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. [ABSTRACT FROM AUTHOR]

Multi-sectoral health care alliances (MHCAs) are organizations that bring together diverse stakeholders to work collaboratively to improve health and health care in local communities. MHCA awareness is a necessary condition for cultivating and sustaining coordinated efforts among participants to improve the quality of care in a community, yet little research has examined whether MHCAs have actually fostered high levels of awareness among participants or how they go about doing so. This mixed method study used quantitative data drawn from three rounds of survey data from MHCA participants to assess the degree of MHCA awareness. It also examined whether perceptions of leadership effectiveness and management style were associated with differences in awareness at the level of the individual alliance participant, member organizations, and the community at large. Interviews with participants examined the approaches undertaken by MHCAs to foster awareness among individuals, organizations, and the community at large as well as the challenges MHCAs confront in raising awareness at each of these different levels. Findings indicate higher levels of awareness among individual participants, while awareness was perceived to be lowest at the community level. Perceptions of leadership effectiveness exhibited the most robust relationships across these three levels; it was positively associated with individual- and community-level awareness. The qualitative analysis identified variations in the strategies being used and the challenges arising at the different levels and indicated that awareness building occurred sequentially across these levels, suggesting a need for more systemic approaches to promoting awareness of these alliances and their efforts. [ABSTRACT FROM AUTHOR]