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Regional health quality improvement coalitions have aimed to promote and coordinate improvement across various levels and types of health care organizations in particular geographic areas. However, the general factors involved in coalitions’ successes or failures are largely unknown. This report looks in depth at four such coalitions — the Cleveland Health Quality Choice Program (now defunct), Minnesota’s Institute for Clinical Systems Improvement, the Rochester Health Commission, and the Pittsburgh Regional Healthcare Initiative — and seeks to find common issues and conditions that influence a coalition’s sustainability and its success in improving regional health care. The authors review the four groups’ general history and highlight issues that arose as the initiatives progressed. From these case study findings, the authors build a conceptual model and review a related set of observations and testable hypotheses regarding factors that may contribute to a coalition’s success.

The research described in this report was supported by the Robert Wood Johnson Foundation. The research was conducted by RAND Health within the Health Sciences program.

This report is part of the RAND Corporation technical report series. RAND technical reports may include research findings on a specific topic that is limited in scope or intended for a narrow audience; present discussions of the methodology employed in research; provide literature reviews, survey instruments, modeling exercises, guidelines for practitioners and research professionals, and supporting documentation; or deliver preliminary findings. All RAND reports undergo rigorous peer review to ensure that they meet high standards for research quality and objectivity.

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