Chapter 5. Measure Maps and Profiles (continued, 4)

Measure #5. Care Coordination Measurement Tool (CCMT)

Care Coordination Measure Mapping Table

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

Care Coordination Measurement Tool (CCMT)

Purpose: To collect information (activities, resource-use, outcomes, time) on care coordination encounters for the purpose of determining the cost of care coordination and related outcomes.

Care coordination encounters were defined as “any activity performed by any primary care office-based personnel that contributed to the development and/or implementation of a plan of care for a patient or family.”²

Format/Data Source: Written form placed at office workstations and filled out by health care providers and staff at the time the care coordination encounter occurs. Providers received instruction on how to fill out the form.

Date: Measure released in 2004.¹

Perspective: Health Care Professional(s)

Measure Item Mapping:

• Establish accountability or negotiate responsibility: Staff
• Communicate:
  • Between health care professional(s) and patient/family: Activity to Fulfill Needs: 1a, 1b, 2a, 2b
  • Within teams of health care professionals: Activity to Fulfill Needs: 1e, 1g, 2e, 2g, 5
  • Across health care teams or settings: Activity to Fulfill Needs: 1c-h, 2c-h, 3a-d, 10a-d
  • Participants not specified: Activity to Fulfill Needs: 7a, 7b, 12
• Information transfer:
  • Participants not specified: Activity to Fulfill Needs: 4, 6, 8; Outcomes: 2k
• Facilitate transitions:
  • Across settings: Outcomes: 2b-I; Care Coordination Needs: 3; Focus Encounter: 6
• Assess needs and goals: Outcomes: 2m, 2n
• Create a proactive plan of care: Activity to Fulfill Needs: 11
• Monitor, follow up, and respond to change: Outcomes: 2j; Care Coordination Needs: 2, 4
• Support self-management goals: Outcomes: 2a
• Link to community resources: Focus Encounter: 3, 4, 8
• Align resources with patient and population needs: Outcomes: 2l
• Care management: Care Coordination Needs: 5; Focus Encounter: 7

Development and Testing: Pilot testing was conducted in several general pediatric practices with varying sizes, locations, patient demographics, and care coordination models. The tool was successfully used to document care coordination encounters during the daily operations of pediatric primary care offices. Statistical comparisons across practices were not performed due to heterogeneity in practice type, sample design, and study methodology.²

Link to Outcomes or Health System Characteristics: Use of the CCMT provided outcomes-based information on trends in costs, resource utilization, and patient characteristics associated with care coordination activities for children with special health care needs. Information included associations between patient complexity and time spent coordinating care, number of encounters, and type of care coordination required. Estimates of the annual cost of the time spent coordinating care and average cost of care coordination activities were also calculated based on data collected.¹

Logic Model/Conceptual Framework: None described in the sources identified.

Past or Validated Applications:

• Setting: Pediatric primary care; the CCMT has also been adapted by subspecialty providers across the U.S. (R.C. Antonelli, personal communication, August 31, 2010).
• Population: Children with special health care needs; this instrument has also been adapted specifically for cardiology ambulatory care and cleft lip and palate care (R.C. Antonelli, personal communication, September 26, 2010).
• Level of evaluation: Practice

Notes:

• All instrument items are located in the Appendix of the source article.²
• This instrument contains 76 items; 56 were mapped.

Sources:

1. Antonelli RC, Antonelli DM. Providing a medical home: The cost of care coordination services in a community-based, general pediatric practice. Pediatrics 2004;113:1522-28.
2. Antonelli RC, Stille CJ, Antonelli DM. Care coordination for children and youth with special health care needs: A descriptive, multi-site study of activities, personnel costs and outcomes. Pediatrics 2008;122:e209-16.

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Measure #6. Client Perception of Coordination Questionnaire (CPCQ)

Care Coordination Measure Mapping Table

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

Client Perceptions of Coordination Questionnaire (CPCQ)

Purpose: To measure patient-centered care and care coordination in health care delivery from a consumer perspective.

Format/Data Source: 31-item, written, self-administered survey addressing 6 domains of care coordination: (1) identification of need, (2) access to care, (3) patient participation, (4) patient-provider communication, (5) inter-provider communication, (6) global assessment of care. These six domains spanned 4 areas of health care provision: (1) overall care, (2) general practitioner (GP) care, (3) nominated provider care, and (4) carers. Questions are answered via Likert scale responses.

Date: Measure released in 2003.¹

Perspective: Patient/Family

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 9
• Communicate:
  • Between health care professional(s) and patient/family: 11, 13
  • Across health care teams or settings: 17, 25
• Interpersonal communication:
  • Between health care professional(s) and patient/family: 19, 27
• Information transfer:
  • Between health care professional(s) and patient/family: 6
  • Across health care teams or settings: 5
• Assess needs and goals: 16
• Create a proactive plan of care: 19, 27
• Monitor, follow up, and respond to change: 10
• Support self-management goals: 14, 18, 20, 26, 28
• Align resources with patient and population needs: 3
• Teamwork focused on coordination: 7
• Medication management: 4

Development and Testing: The instrument was developed through iterative item generation. Most items achieved excellent completion and comprehension rates, and the instrument was transferable among chronically unwell populations. Six scales were identified based on principle components analysis (acceptability, received care, GP, nominated provider, client comprehension, and client capacity). Construct validity, comprehensibility, and internal consistency were demonstrated for all scales but client comprehension and capacity. Construct validity was further supported by the finding that patients with chronic pain syndromes reported significantly worse experiences for all items. Individual items in the instrument were found to be relevant to care coordination, although authors suggest further testing and possible revisions for the measure. Testing was conducted in association with the Australian Coordinated Care Trials using data from 1193 survey responses.¹

Link to Outcomes or Health System Characteristics: None described in the sources identified.

Logic Model/Conceptual Framework: None described in the sources identified.

Past or Validated Applications:

• Setting: Community-based general practices; Australia
• Population: People with complex and chronic health care needs
• Level of evaluation: Health Care Professional(s)

Notes:

• All instrument items are located in the Appendix of the source article.¹
• This instrument contains 31 items; 23 were mapped.

Sources:

1. McGuiness C, Sibthorpe B. Development and initial validation of a measure of coordination of health care. Int J Qual Health Care 2003;15(4):309-18.

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Measure #7a. Collaborative Practice Scale (CPS) — Nurse Scale

Care Coordination Measure Mapping Table

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

Collaborative Practice Scale (CPS) — Nurse Scale

Purpose: To assess the interactions between nurses and physicians during typical delivery-of-care processes.

Format/Data Source: 9-item, self-administered, written survey. Questions are answered on a 6-point Likert scale and totaled. Higher scores indicate greater collaboration. For the purposes of this instrument, collaboration is defined as “interactions between nurse and physician that enable the knowledge and skills of both professionals to synergistically influence the patient care provided.”¹ The instrument focuses on 2 factors: (1) communication and (2) clarification of responsibilities.

Date: Measure released in 1985.¹

Perspective: Health Care Professional(s)

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 1-4, 6-9
• Communicate:
  • Within teams of health care professionals: 3, 5, 7-9
• Interpersonal communication:
  • Within teams of health care professionals: 1, 2, 4, 6
• Teamwork focused on coordination: 1-9

Development and Testing: The instrument was tested in a sample of 94 physicians. Significant test-retest reliability was established, as was construct validity. Factor analysis confirmed the presence of two distinct factors measuring unique components of collaboration. Concurrent validity was tested by comparison of the CPS to 2 other instruments: (1) Management of Differences Exercise (MODE) and (2) The Health Role Expectation Index (HREI). A correlation was found only between the CPS and the HREI. Predictive validity was assessed by comparing peer reviews of interprofessional practice by nurses for physicians and by physicians for nurses with the CPS scores. Adequate validity correlations were not found for the nurse scale. Authors suggest that further testing for predictive and concurrent validity is warranted.¹

Link to Outcomes or Health System Characteristics: Measure developers indicate that further testing of theory-linked factors related to the instruments is necessary.

Logic Model/Conceptual Framework: None described in the sources identified.

Past or Validated Applications:

• Setting: Urban health centers in the United States (not inpatient or outpatient specific)
• Population: Nurses
• Level of evaluation: Health Care Professional(s)

Notes:

• All instrument items are located in Table 1 of the source article.¹
• This instrument contains 9 items; all 9 were mapped.

Sources:

1. Weiss SJ, Davis HP. Validity and reliability of the collaborative practice scales. Nurs Res 1985;34:299-305..
2. Dougherty MB, Larson E. A review of instruments measuring nurse-physician collaboration. J Nurs Adm 2005;35(5):244-53.

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Measure #7b. Collaborative Practice Scale (CPS) — Physician Scale

Care Coordination Measure Mapping Table

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

Collaborative Practice Scale (CPS) — Physician Scale

Purpose: To assess the interactions between nurses and physicians during typical delivery of care processes.

Format/Data Source: 10-item, self-administered, written survey. Questions are answered on a 6-point Likert scale and totaled. Higher scores indicate greater collaboration. For the purposes of this instrument, collaboration is defined as “interactions between nurse and physician that enable the knowledge and skills of both professionals to synergistically influence the patient care provided.”¹ The instrument focuses on 2 factors: (1) communication and (2) clarification of responsibilities.

Date: Measure released in 1985.¹

Perspective: Health Care Professional(s)

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 6, 8, 10
• Communicate:
  • Between health care professional(s) and patient/family: 1
• Interpersonal communication:
  • Within teams of health care professionals: 2, 3, 5, 6, 8-10
• Create a proactive plan of care: 4
• Teamwork focused on coordination: 1-10

Development and Testing: The instrument was tested in a sample of 94 physicians. Significant test-retest reliability was established, as was construct validity. Factor analysis confirmed the presence of two distinct factors measuring unique components of collaboration. Concurrent validity was tested by comparison of the CPS to 2 other instruments: (1) Management of Differences Exercise (MODE) and (2) The Health Role Expectation Index (HREI). A correlation was found only between the CPS and the HREI. Predictive validity was assessed by comparing peer reviews of interprofessional practice by nurses for physicians and by physicians for nurses with the CPS scores. Adequate validity correlations were not found for the nurse scale. Authors suggest that further testing for predictive and concurrent validity is warranted.¹

Link to Outcomes or Health System Characteristics: Measure developers indicate that further testing of theory-linked factors related to the instruments is necessary.

Logic Model/Conceptual Framework: None described in the sources identified.

Past or Validated Applications:

• Setting: Urban health centers in the United States (not inpatient or outpatient specific)
• Population: Physicians
• Level of evaluation: Health Care Professional(s)

Notes:

• All instrument items are located in Table 1 of the source article.¹
• This instrument contains 10 items; all 10 were mapped.

Sources:

1. Weiss SJ, Davis HP. Validity and reliability of the collaborative practice scales. Nurs Res 1985;34:299-305..
2. Dougherty MB, Larson E. A review of instruments measuring nurse-physician collaboration. J Nurs Adm 2005;35(5):244-53.

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