Care Coordination Measures Atlas Project (Text Version)

On September 27, 2010, Kathryn McDonald made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (809 KB). 

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Slide 1

Care Coordination Measures Atlas Project

Kathryn McDonald
Stanford University
AHRQ Quality Indicators Project

Slide 2

Project Team

Stanford/Battelle:

• Ellen Schultz
• Lauren Albin
• Noelle Pineda
• Julia Lonhart
• Crystal Smith-Spangler
• Jennifer Brustrom
• Vandana Sundaram
• Elizabeth Malcolm (Sutter)
• Kathryn McDonald

AHRQ:

• David Meyers
• Jan Genevro
• Mamatha Pancholi

Slide 3

Project Context: Measurement Motivation

• Patient-Centered Medical Home
• Evidence-based Practice Center (EPC) report on care coordination
• HIT advances and opportunities
• Transparency objectives: evidence & evaluations

Slide 4

Project Objective: Develop Measures Atlas

• Target scope
  • Ambulatory care
  • Patients who have access to healthcare
• The Atlas aims to support the field of care coordination measurement by:
  • Finding, selecting and cataloging existing measures of care coordination
  • Present best measures in accessible format
• Expected Atlas Users:
  • Evaluators of interventions or demonstration projects that aim to improve care coordination
  • Quality improvement practitioners
  • Researchers studying care coordination

Slide 5

Methods

• Literature search
• Environmental scan
  • 2 workgroups and other informants
• Framework development
• Expert review
• "Mapping" measures for two purposes:
  • Visualize landscape of measures available (and missing)
  • Help users target care coordination domains for intervention and measurement
• Detailed measure profiles

Slide 6

Results

Area	Lessons Learned
Definitions Measurement Framework	Many available Depends on perspective Notion of "failures" White space Two dimensions Care coordination domains Perspectives Links to outcomes of interest (clinical, resource, IOM 6 dimensions of quality)

Slide 7

Goal: Coordinated Care

Image: Flowchart shows the mechanisms and measures for coordinated care. The process is described below:

Level 1: Mechanisms. Means of achieving goal.

Level 2: 1) Coordination Activities. Actions hypothesized to support coordination. Not necessarily executed in structured way. 2. Broad Approaches. Commonly used groups of activities and/or tools hypothesized to support coordination. An arrow points down from "Coordination Activities" and "Broad Approaches" to:

Level 3: Coordination Effects: Experienced in different ways depending upon the perspective. Lines extend down from "Coordination Effects" to the following 3 items in Level 4:

• Patient/Family Perspective
• Healthcare Professional Perspective
• System Representative Perspective

An arrow points down from "Healthcare Professional Perspective" to Level 5: Coordination Measures.

At the bottom of the chart is a note: "Context: Settings; Patient Populations; Timeframe; Facilitators; Barriers."

Slide 8

Measure Mapping Table

	Measurement Perspective
	Patient/Family	Healthcare Professional(s)	System Representative(s)
Care Coordination Activities
Establish accountability or negotiate responsibility
Communicate
Interpersonal Communication
Information Transfer
Facilitate transitions
Across settings
As coordination needs change
Assess needs and goals
Create a proactive plan of care
Monitor, follow-up, and respond to change
Support self-management goals
Link to community resources
Align resources with patient and population needs
Broad Approaches Potentially Related to Care Coordination
Teamwork focused on coordination
Healthcare Home
Care Management
Medication Management
Health IT-enabled coordination

Slide 9

Results: Measures

• Identified 150 measures
• Mostly survey-based
• Included better measures based on:
  • Previous testing, use and/or underlying logic model
  • Applicability
• Final measure count: 52

Slide 10

Measure Mapping and Profile

• Refer to handout
• CTM-15
  • 12: When I left the hospital, I had a readable and easily understood written list of the appointments or tests I needed to complete within the next several weeks.
• CAHPS
  • CC1!: Doctor talked with patient about all of the prescription medicines he/she was taking
  • SP5: Patient phoned doctor's office for help or advice after surgery or procedure

Slide 11

Next Steps

• Text version available
• Development of Web -based version
  • Searchable
  • Explicit links to care coordination-related measures included in Electronic Health Record Incentive Program (Medicare and Medicaid)
  • Additional user testing and input
  • Section on applicability to practice's ongoing QI efforts
• Systematic research on evidence base on measurable mechanisms hypothesized to produce better care coordination (process-outcome links)