Community-Level Quality Improvement and the Patient Experience for Chronic Illness Care

Health Serv Res. 2016 Feb;51(1):76-97. doi: 10.1111/1475-6773.12315. Epub 2015 May 18.


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.

Keywords: Quality improvement; chronic illness; patient experience.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chronic Disease / therapy*
  • Community Health Services / organization & administration*
  • Community Health Services / standards
  • Continuity of Patient Care / organization & administration
  • Diabetes Mellitus / therapy
  • Female
  • Health Behavior
  • Health Services Research
  • Humans
  • Life Style
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Professional-Patient Relations
  • Quality Improvement / organization & administration*
  • Socioeconomic Factors
  • Time Factors