Expecting Success: Excellence in Cardiac Care Results from Robert Wood Johnson Foundation Quality Improvement Collaborative

Publication Date: November 2008

Publisher: Robert Wood Johnson Foundation


Research Area: Health

Type: Report


The United States spends twice as much money per person on health care than anywhere on earth, but ranks 18th worldwide in average life expectancy—behind Australia, Canada, France, Japan and others. Given that America spends so much more money on health care, one would hope that Americans have better health outcomes than anyone else. So why the gap?

Most experts say that the answer lies in the quality of care Americans receive. Unfortunately, more care doesn’t always mean better care or the right care. Although the quality of health care is poor for many Americans, certain racial and ethnic groups continually experience worse quality care than white patients. While quality sometimes differs depending on the patient’s geographic location, education level or health insurance status, repeated research has shown that African Americans and Hispanics consistently receive a lower quality of care than their white counterparts, even when all demographic and socioeconomic factors are equal.

In response to the lack of potential disparities solutions, the Robert Wood Johnson Foundation introduced a 29-month-long pilot program in late 2005, aimed at analyzing racial and ethnic disparities in cardiac care at select hospitals across the country. Expecting Success: Excellence in Cardiac Care selected 10 pilot hospitals—from a competitive applicant pool of more than 120—to develop and share tools for improving cardiac care for African-American and Hispanic patients with acute myocardial infarction (AMI) or congestive heart failure (CHF).

The 10 general, acute-care facilities were intentionally diverse in terms of size, geographic location and hospital type—so as to ensure that their learnings would be adaptable and adoptable by hospitals nationwide. What they held in common was:

* a large base of African-American and/or Hispanic patients;
* a willingness to discover where and how disparities may be occurring;
* a proven track record in quality improvement initiatives;
* a readiness to serve as “learning laboratories” for other institutions nationwide; and
* leadership committed to improving cardiovascular care for all patients, particularly minorities.

The Expecting Success participating hospitals focused on the continuum of cardiovascular care with four goals:

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

Lessons learned from the pilot phase of Expecting Success: Excellence in Cardiac Care will be spread to hospitals in communities nationwide as part of the Robert Wood Johnson Foundation’s groundbreaking Aligning Forces for Quality program. This $300-million initiative seeks to lift the quality of health and health care in select communities by teaming up with those who get care, give care and pay for care. The program is applying a wealth of resources, expertise and training to effect real improvements in health care quality.