Improving Chronic Illness Care

Americans receive only about 55 percent of the recommended quality of care. The Robert Wood Johnson foundation is attempting to change that through their new initiative--Aligning Forces for Quality--and has selected Dennis Scanlon, associate professor of health policy and administration in the College of Health and Human Development, to lead evaluation of the program.

Dennis Scanlon

Aligning Forces is designed to help communities to advance the quality of care for chronic illnesses, such as diabetes, heart disease, depression, and asthma. Improvements in this area have been complicated by the adverse interests of the major players in the health care system. "We're talking about groups with competing interests, like doctors and insurers," says Scanlon. Now the Foundation is asking "Can communities make this happen, and how?"

The program seeks to help communities work with physicians to improve the quality of the chronic illness care provided by the physicians, measuring physician performance, and making that information available to health care consumers. The expectation is that once these three key drivers are aligned, educated consumers will demand higher quality care and the communities will see more and faster improvement in chronic illness outcomes. The first four communities - Detroit, Minneapolis/St. Paul, Memphis, and Seattle each received grants from the Foundation of $600,000 to use over three years for planning, convening, coordination and infrastructure development.

Ten additional communities were selected this month to join the initiative:

• Cincinnati, OH
• Cleveland, OH
• Humboldt County, CA
• Kansas City, MO
• Maine
• Western Michigan
• Western New York
• Willamette Valley, OR
• Wisconsin
• York, PA

In addition to their grant awards, the communities will have access to a substantial pool of technical assistance from experts in such areas as quality improvement and patient education. During initial phase planning, each community must develop specific, quantifiable milestones and benchmarks to achieve substantial improvement in the three areas.

The evaluation effort will be administered by the Center for Health Care and Policy Research, and includes a team of national experts on organizational behavior, health care quality, and health systems change. Scanlon and the team will evaluate the communities' efforts and progress towards the benchmarks set by the communities and the Foundation. "[We] will be looking at what approaches communities are taking and then analyzing the impact on health care outcomes in the areas of chronic diseases such as diabetes, asthma, and heart failure. [We] want to be able to identify what changes work best to improve the system." explains Scanlon.

This effort builds on Scanlon's prior research focusing on national efforts to reduce medical errors and improve health-care quality. He is a recipient of the Robert Wood Johnson Foundation Investigator in Health Policy Research Award and also has received funding from the Centers for Disease Control, the Agency for Healthcare Research and Quality, The California HealthCare Foundation and the Integrated Benefits Institute.