HE INSTITUTE OF MEDICINE and others have documented a chasm between the medical care Americans have and the care we should have, even for common chronic conditions such as asthma and diabetes. A landmark RWJF-funded study by RAND® found that patients receive the recommended standard of care only about half the time.
Ensuring that all Americans, especially those with chronic conditions, receive high-quality care is central to the Foundation’s mission of improving health and health care. Most care for chronic conditions—and most spending on care for those conditions—occurs in outpatient settings. Too often, people receive treatment that does not meet recommended guidelines, is uncoordinated, and lacks proper follow-up care and information. The result can be unnecessary hospitalization and expense.
In 2004 RWJF pursued a four-pronged approach to improve the quality of care for chronic disease in outpatient settings:
- National Measures for Quality. To improve the quality of care, we need to first agree on what “quality” means and how to measure it. To that end, we provided support to the National Quality Forum, a group of providers, patients, purchasers/payers and researchers, to build consensus around reliable measures of quality.
- Engage Patients and Purchasers in Assessing Quality. Patients and purchasers need to be involved to ensure that the care they receive and pay for meets quality standards. The Foundation’s Rewarding Results national program continued to help purchasers test the effectiveness of incentives for higher quality care. In 2004 we awarded a grant to the National Partnership for Women and Families to plan an effort to engage consumers in demanding quality care.
- Demonstrate that High Quality is Achievable Where Providers, Purchasers and Patients are Aligned Around Common Quality Standards. Working with multiple partners in selected markets, we will launch demonstration projects that align providers, purchasers and patients around common quality goals to raise the standard of care so that outpatient quality standards are met most of the time rather than only half the time. If successful, consumers in these markets will have access to information about the quality of care, and providers will have demonstrated skills in adopting the principles of the Chronic Care Model.
- Track Progress. It remains critical to track progress toward achieving better care. The Foundation is supporting work to examine whether more purchasers are making decisions based on quality; whether more patients are becoming engaged in managing their own care and ensuring the care they receive is of high quality; and whether more providers are adopting the tools and systems they need to provide high-quality care. For example, through a 2004 grant to the University of California, Berkeley School of Public Health, researcher Stephen Shortell is tracking the implementation and use of preventive services and evidence-based care management processes in the care of asthma, congestive heart failure, depression and diabetes.
We integrated our longstanding efforts to build and sustain the field of end-of-life care into our
larger body of work to enhance the quality of health care. Our work in this field has brought together
and mobilized health professionals, consumers, families, legislators, attorneys general and others to
improve both policy and practice. What constitutes good care for Americans in their final stages of
life—once an issue that was ignored or swept under the rug—is now an integral component of a
high-quality health care system. RWJF continued to support this movement through entities such as the
Center to Advance Palliative Care and the National Hospice and Palliative Care Organization. 
Grantmaking Portfolio Overview