The California wellness foundation's Health Improvement Initiative: evaluation findings and lessons learned.

Purpose: To evaluate the effect of the Health Improvement Initiative (HII), a 5-year grantmaking initiative funded by The California Wellness Foundation designed to identify the critical factors needed to bring about population health improvements through community-level systems change.

Design: The evaluation of the HII used a case-study, logic-model approach to make inferences about the effect of each community coalition (Health Partnership) on its target community. The primary outcome measure was the creation of significant and sustainable community-level systems change.

Setting: The HII included nine communities in California that received funding to create broad-based Health Partnerships.

Subjects: Primary data were collected from a variety of Initiative stakeholders by key informant interviews, closed-ended surveys, and participant observation.

Intervention: The HII provided funding over 5 years to nine Health Partnerships that were intended to be a driving force in implementing community-level systems change. The ultimate objective of the systems change process was to improve "population health, " broadly defined to include social economic, and cultural determinants of health, in addition to traditional health status indicators.

Measures: Both qualitative and quantitative techniques were used to assess the effect of the HII on key community systems. The primary outcomes were qualitative descriptions of community-level changes.

Results: At the end of the 5 years of HII funding, six of the nine Partnerships had played a critical role in implementing sustainable systems changes that would likely have a significant effect in their target communities.

Conclusion: The HII was successful in promoting community-level systems change in the majority of funded communities, although the evidence was mixed regarding the role of the Partnerships in bringing about these changes.