Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s signature effort to lift the quality of health care in 16 diverse communities, reduce racial and ethnic disparities, and provide models for national reform. AF4Q brings together people who get care, give care, and pay for care to work together toward the shared goal of better health and health care.

Today's issue of Spotlight features the work of AF4Q's Memphis Alliance.

Memphis, TN, is a city of diversity. According to the latest census data, 63 percent of the population is African American. Common Table Health Alliance (CTHA), leader of the Aligning Forces for Quality (AF4Q) initiative in Memphis, is leading hospitals toward gathering information on patient race, ethnicity, and language preference (R/E/L) to identify any gaps in health care among different populations.
  
CTHA’s findings in its Health Equity report show disparities in care between African Americans and other racial groups in Memphis. The African American Medicare population is much less likely to visit their primary care clinician than their counterparts of other races. In Memphis, barriers such as cost, proximity of primary care clinicians, and availability of transportation services all contribute to disparities in care. African Americans are three times more likely to have a lower extremity amputated due to complications from diabetes than other racial groups. Mammograms are also a problem area for equity; African American women in Memphis are much less likely to use this preventive tool. This may put African American women at a higher risk of death from breast cancer. This results in a disproportionate number of deaths from breast cancer among African American women.

To address these disparities, CTHA continues to gather data stratified by R/E/L and engage organizations in cultural competency  discussions which enhance opportunities for improvement, and ultimately foster a culture of equity.

One of the most pressing problems in health care is the lack of connection between national-level problems and local delivery. Common Table Health Alliance (CTHA), leader of the Aligning Forces initiative in Memphis, is seeking to connect local hospitals to national outcomes by setting benchmarks for quality and comparing data among hospitals.

CTHA has negotiated with all Memphis-area hospitals (10 locations) to share blinded data for comparison. Quality improvement directors from each hospital decided to meet every other month to discuss what’s working and what’s not. These peer-to-peer meetings, informally called “the breakfast club,” allow hospital staff to share and define their commitment to achieving good-quality, equitable care in Memphis.

“Every quality improvement director has their hands full, and oftentimes we don’t get the opportunity to reach out to our peers around the city. We find that we all have the same struggles. We try to get our arms around some of the same information, like readmissions for heart failure and pneumonia,” said Pearlie Pilgram, director of clinical quality improvement at Saint Francis Hospital. “This is a tremendous opportunity for us.”

People in Memphis, TN, suffer from Type II diabetes rates above the national average. Diabetes and pre-diabetes contribute to the majority of premature deaths in Tennessee.

At the front lines of care, primary care physicians in Memphis tackle treating patients with diabetes with the help of Project Better Care, a program from Common Table Health Alliance (CTHA). The guiding principle of Project Better Care (PBC) is that patients are best served by preventive care in primary care practices. Patients with diabetes are more likely to receive high-quality care if they have regular visits from a primary care provider with whom they have a strong, stable relationship.
     
Representatives from the 11 PBC practices convene quarterly for a learning collaborative. Said Dr. Susan Nelson, medical director of CTHA, “Providers are finding new ways to do old things at the learning collaboratives. There’s such energy and excitement in the room. They come away with tools to help patients.” For example, one practice developed a diabetes care flowchart and quickly shared it among PBC practices. “The small practices aren’t isolated any more, and it’s making a difference,” said Dr. Nelson.