About the Comparative Health Systems Performance (CHSP) Initiative


AHRQ created the Comparative Health System Performance Initiative to study how health care systems promote evidence-based practices in delivering care. The initiative provides about $52 million over 5 years to establish three Centers of Excellence and a Coordinating Center to identify, classify, track, and compare health systems. AHRQ’s goal is to understand the factors that affect health systems’ use of patient-centered outcomes research (PCOR) and to identify best practices in disseminating and using PCOR.


The effective adoption and use of PCOR evidence holds promise as a way to improve clinical outcomes and reduce costs. However, little is known about the characteristics of high-performing health systems and the factors that affect their acceptance and use of PCOR evidence. The Comparative Health System Performance Initiative will address these knowledge gaps and accelerate the diffusion of PCOR evidence among health systems.


  • Classify and characterize types of health systems and compare their performance in terms of clinical and cost outcomes.
  • Identify characteristics of high-performing health systems.
  • Evaluate the role of PCOR in health system performance.
  • Disseminate findings broadly to help diffuse PCOR evidence across health systems nationally.

Core Activities

Establish three Centers of Excellence (CoE) to:

  • Develop a data core to systematically track health systems, their characteristics, and their performance on quality and cost outcomes.
  • Identify, characterize, and classify the proliferating forms of health systems.
  • Assess the use of PCOR evidence among health systems.
  • Evaluate the association between use of PCOR evidence and quality and cost of care.
  • Identify characteristics of high-performing health systems, the influence of external environments on high performance and PCOR adoption, and the role of PCOR evidence in these systems.
  • Disseminate findings to health system leadership, patients and consumers, policymakers, and payers.

Create a Coordinating Center to:

  • Facilitate collaboration between the Centers of Excellence and convene stakeholders and technical experts.
  • Synthesize findings from the Centers of Excellence and conduct data analyses.
  • Develop a compendium on health system performance that includes information on system characteristics.
  • Promote broad dissemination of findings on the characteristics of high-performing health systems and factors influencing the successful adoption of PCOR evidence.

Focus Areas of the Centers of Excellence

Market and Organizational Factors That Influence Implementation of Innovations

Dartmouth College, in partnership with the University of California at Berkeley, Harvard University, and the High Value Healthcare Collaborative

This center will:

  • Conduct a national survey of health care organizations and systems.
  • Study how market and organizational factors influence the implementation of biomedical, health system, and patient engagement innovations.

National Database To Study Health Systems Nationally

National Bureau of Economic Research, in partnership with many collaborators, including Harvard University, the Health Research & Educational Trust, and the Network of Regional Healthcare Initiatives

This center will:

  • Create a national database, including administrative and survey data, to identify and characterize high-performing health systems and measure their outcomes.
  • Study health systems with a focus on cancer care, pediatric health care delivery, dialysis, and post-acute care.

Role of incentives, Health Information Technology, and Organizational Integration Within Systems

RAND Corporation, in partnership with Pennsylvania State University, University of California at Los Angeles, Harvard University, and five regional health improvement collaboratives

This center will:

  • Construct an integrated data library with administrative and survey data, as well as findings from interviews and focus groups.
  • Explore the role of incentives, use of health IT, organizational integration, and strategies used by federally qualified health centers to improve performance.

For more information, contact CHSP@ahrq.hhs.gov.

Page last reviewed May 2019
Page originally created September 2016
Internet Citation: About the Comparative Health Systems Performance (CHSP) Initiative. Content last reviewed May 2019. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/chsp/about-chsp/index.html
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