Program Overview

Expecting Success is a national program of the Robert Wood Johnson Foundation (RWJF) intended to improve the quality of health care provided to minority populations in the United States. This program is part of the RWJF's overall effort to develop solutions to the well-documented problem of racial and ethnic disparities in health care. The Expecting Success program consists of hospitals across the country applying quality improvement techniques to the challenge of reducing health care disparities.

Expecting Success is focusing on the continuum of cardiovascular care delivered in inpatient and outpatient settings with four goals:

• To improve cardiovascular care for African Americans and Latinos;
• To develop effective, replicable quality-improvement strategies, models and resources;
• To encourage the spread of those strategies and models to clinical areas outside of cardiac care; and
• To share relevant lessons with health care providers and policy-makers.

Under the Expecting Success program, ten general acute care hospitals, selected on a competitive basis, are participating in a 29-month long collaborative process to improve the quality of care for African Americans and Latinos with cardiovascular disease. The hospitals work in two specific areas:

• Improving the quality of inpatient care for minority patients with cardiovascular disease; and
• Initiating innovations or improvements in community care designed to elevate the quality of care provided to minority patients with cardiovascular disease outside the hospital setting.

Sites work collaboratively to share potential quality improvement models, implementation strategies, and lessons learned. They also seek to spread innovations developed as a result of this project to other health care services provided by the hospital and community. Data collected and reported by each participating hospital is being shared among the sites. All program activities are conducted within the framework of a collaborative 'Learning Network' managed by a National Program Office (NPO) designed to foster shared learning and innovation among all program participants. The NPO operates from The George Washington University Medical Center School of Public Health and Health Services.

Improving Inpatient Effectiveness of Care

Ten selected hospitals receive a grant and ongoing assistance as part of their participation in the Learning Network. The NPO assembled a cadre of experts in quality improvement, evidence-based practice, survey and sampling methodologies, collection of race and ethnicity data, and other areas. These experts work closely with a team from each grantee hospital to utilize quality improvement methods to improve care for minority patients with cardiovascular disease. Each site will be assessed in terms of its readiness for change and is creating an 'Improvement Plan' to guide its activities in improving cardiac care.

Sites received training in and use uniform methods to collect and submit standardized race and ethnicity specific data on a select uniform set of measures. These metrics include the Centers for Medicare and Medicaid Services (CMS) Hospital Quality Alliance measures for patients with acute myocardial infarction (AMI)/heart attack and/or congestive heart failure (CHF), other clinical measures, as well as measures of compliance with evidence-based practice protocols. The data is charting sites' progress and allowing for quality improvement interventions using Rapid Cycle Change techniques. Surveys of patient experiences are also being collected and analyzed for the sites' use and for evaluation purposes.

Community Demonstration Projects

All grantees under the Expecting Success program are developing and implementing their own demonstration project aimed at extending quality cardiac care outside of the hospital walls into the surrounding community. Applicants were asked to propose ideas for these projects that could potentially be harvested by other hospitals in the field.

Grantee hospitals are identifying and creating partnerships with appropriate local providers to improve the broader continuum of care to minority patients with cardiovascular disease. Together, hospitals and their local partners are implementing demonstrations that use either entirely new strategies or interventions that have been implemented elsewhere but whose outcomes have not been rigorously assessed.

These demonstration projects are intended to help further the 'state of the art' of delivering cardiovascular care to minority populations. Each site is required to report regularly on a set of appropriate metrics to chart the progress of the intervention (e.g., inter-hospital transfer rates, procedure rates, use of beta blockers and smoking cessation counseling post-discharge). Limited technical assistance tailored to the specific projects is available from the NPO.

Market Assessments

One of the program's underlying principles is that hospitals cannot improve the quality of care without gaining a better understanding of the health care market in which they operate. Therefore, Expecting Success is conducting cardiovascular care market assessments to provide comprehensive descriptions of key aspects of health care delivery in each of the hospital site communities. The assessments are primarily intended to serve as a resource to the sites, and to inform their activities in all phases of the project. The assessments are reviewing trends in local demographics, disease prevalence, health care delivery, finance and insurance and seek to identify potential barriers for underserved minority populations in accessing high-quality cardiovascular care.

Sites are receiving several reports related to the market assessment of their community. Public reports highlighting some of the major issues found in the assessment will also be prepared.