Chapter 5. Measure Maps and Profiles (continued, 7)

Measure #13. Primary Care Assessment Survey (PCAS)

Care Coordination Measure Mapping Table

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

Primary Care Assessment Survey (PCAS)

Purpose: To assess the performance of primary care physicians from the patient perspective.

Format/Data Source: 51-item, self-administered survey assessing primary care across 7 domains: (1) accessibility (organizational, financial), (2) continuity (longitudinal, visit-based), (3) comprehensiveness (contextual knowledge of patient, preventive counseling), (4) integration, (5) clinical interaction (clinician-patient communication, thoroughness of physical examinations), (6) interpersonal treatment, and (7) trust. A 3-step mail survey protocol was used with limited telephone followup. All PCAS items are non-visit specific to emphasize primary care in a sustained clinician-patient relationship. Responses were provided on a Likert scale.

Date: Measure published in 1998.¹

Perspective: Patient/Family

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 35
• Communicate:
  • Between health care professional(s) and patient/family: 12, 28, 30, 32, 33, 42, 46
  • Across health care teams or settings: 27
• Interpersonal communication:
  • Between health care professional(s) and patient/family: 31, 35
• Information transfer:
  • Participants not specified: 13
• Facilitate transitions:
  • Across settings: 24-26
• Assess needs and goals: 15, 16
• Monitor, follow up, and respond to change: 25, 26
• Support self-management goals: 17-24, 34

Development and Testing: Through the use of Likert's method, 5 testing assumptions were met, specifically: (1) item-convergent validity, (2) item-discriminant validity, (3) equal item variance, (4) equal item-scale correlations, and (5) score reliability. Test-retest reliability determined stability of responses. Cronbach's alpha coefficients for each subscale substantially exceeded the recommended value.¹

Link to Outcomes or Health System Characteristics: Strong associations are demonstrated between PCAS scales and outcomes such as patients' adherence to physicians' advice, patients' understanding of and ability to manage a chronic health condition, patients' satisfaction with their primary physicians, and patients' self-reported health improvements.¹

Logic Model/Conceptual Framework: The foundation for the PCAS came from the Institute of Medicine's definition of primary care.¹

Past or Validated Applications:

• Setting: Primary care in the United States
• Population: Primary care patients
• Level of evaluation: Health Care Professional(s)

Notes:

• The original measure did not have individual items numbered. In order to properly reference specific items within this profile, all instrument items found in Appendix A of the source article were consecutively numbered.¹
• This instrument contains 51 items; 49 were provided in Appendix A (2 were screener items); 22 were mapped.

Sources:

1. Safran DG, Kosinski M, Tarlov AR, et al. The Primary Care Assessment Survey: Tests of data quality and measurement performance. Med Care 1998;36(5):728-39.
2. Safran DG, Montgomery JE, Change H, et al. Switching doctors: Predictors of voluntary disenrollment from a primary physician's practice. J Fam Pract 2001;50(2):130-36.
3. O'Malley AS, Forrest CB. Beyond the examination room: Primary care performance and the patient-physician relationship for low-income women. J Gen Int Med 2002;17:66-74.
4. Montgomery JE, Irish JT, Wilson IB, et al. Primary care experiences of Medicare beneficiaries, 1998 to 2000. J Gen Int Med 2004;19:991-8.

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Measure #14. National Survey of Children With Special Health Care Needs (CSHCN)

Care Coordination Measure Mapping Table

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

National Survey of Children With Special Health Care Needs (CSHCN)

Purpose: To collect information about children with special heath care needs (CSHCN) and their families to help guide policymakers, advocates, and researchers.

Format/Data Source: Telephone interview comprised of 11-13 sections (the 2005-2006 version consists of 11 sections, and the 2001 version consists of 13 sections). The sections most relevant to care coordination are Section 5 — Care Coordination, Section 6A — Family Centered Care, and Section 6B — Transition Issues.

Date: Measure administered nationally in 2001 and 2005-2006.¹

Perspective: Patient/Family

Measure Item Mapping:

• Establish accountability or negotiate responsibility: C6Q08
• Communicate:
  • Across health care teams or settings: C5Q05, C5Q06, C5Q10
• Interpersonal communication:
  • Between health care professional(s) and patient/family: C6Q03, C6A0A, C6A0A_B, C6Q0A_C, C6Q0A_D, C6Q0A_E, C6Q0A_F
• Information transfer:
  • Between health care professional(s) and patient/family: C6Q04
• Facilitate transitions:
  • Across settings: C5Q11, C4Q07
  • As coordination needs change: C6A0A, C6A0A_B, C6Q0A_C, C6Q0A_D, C6Q0A_E, C6Q0A_F
• Assess needs and goals: C6A0A, C6Q0A_D
• Align resources with patient and population needs: S5Q13, S5Q13A
• Care management: C5Q09, C5Q12, C5Q13, C5Q14 INDEX, C5Q15, C5Q16 INDEX

Development and Testing: The survey was conceptualized and developed by an expert panel consisting of selected State and Federal Title V program directors, representatives from Family Voices and the Association for Maternal and Child Health Programs, health services researchers, and survey design experts. All questions were pretested in 2000. After it was administered nationally in 2001, the survey was revised based on suggestions made by data users. Each suggested revision was reviewed by a technical expert panel, and all new or substantially altered questions were pretested in 2004.²

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: United States
• Population: Children with special health care needs
• Level of evaluation: Health Care Professional(s)

Notes:

• This survey consists of many sections, but only the sections relevant to care coordination (Section 5— Care Coordination, Section 6A — Family Centered Care, Section 6B — Transition Issues) were mapped for this profile. The full-length instrument as well as a Spanish version can be found online.¹
• The Measure Item Mapping portion of the profile refers to the question items found in the 2005-2006 version of the survey. For those interested in the 2001 version, it can be found online.¹
• The mapped sections of the measure contain 27 items; 22 were mapped.
• The 2001 and 2005-2006 national and State data are publicly available for download online.¹
• The CSHCN survey questions and data have also been used in several published studies. A list of these publications may be found online.¹

Sources:

1. National Survey of Children With Special Health Care Needs Web site. Available at: http://cshcndata.org/Content/Default.aspx. Accessed: 20 September 2010.
2. Blumberg SJ, Welch BM, Chowdhury SR, et al. Design and operation of the National Survey of Children With Special Health Care Needs, 2005-2006. National Center for Health Statistics. Vital Health Stat 2008;1(45).

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Measure #15. Head and Neck Cancer Integrated Care Indicators

Care Coordination Measure Mapping Table

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

Head and Neck Cancer Integrated Care Indicators

Purpose: To measure the quality of integrated care by assessing current practice for patients with head and neck cancer.

Format/Data Source: 8 integrated care indicators (ICI) and 23 specific indicators (SI) for patients with head and neck cancer.

Date: Measure published in 2007.¹

Perspective: System Representative(s)

Measure Item Mapping:

• Establish accountability or negotiate responsibility: SI 1
• Communicate:
  • Information transfer:
    • Between health care professional(s) and patient/family: ICI 8, SI 3, SI 5
    • Across health care teams or settings: SI 23
    • Participants not specified: SI 2
• Facilitate transitions:
  • Across settings: SI 12, SI 15
• Care management ICI 5, ICI 6

Development and Testing: The indicators were developed using the RAND-modified appropriateness method, which involved systematically searching the literature for integrated care recommendations and performing a systematic consensus procedure based on evidence-based guidelines and the opinions of both professionals and patients. The clinimetric characteristics of the developed indicators were tested. All indicators had acceptable reliability values. The content validity of the indicators was guaranteed by the use of the RAND-modified appropriateness method.¹

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

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

Past or Validated Applications:

• Setting: University hospital in the Netherlands
• Population: University hospital in the Netherlands
• Level of evaluation: Practice (head and neck oncology centers)

Notes:

• All ICI items located in Table 1 and all SI items located in Table 2 of the source article.¹
• This instrument contains 31 items; 11 were mapped.

Sources:

1. Ouwens MMMTJ, Marres HAM, Hermens RRP, et al. Quality of integrated care for patients with head and neck cancer: Development and measurement of clinical indicators. Head Neck 2007;29(4):378-86.

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Measure #16a. Medical Home Index — Long Version (MHI-LV)

Care Coordination Measure Mapping Table

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

Medical Home Index — Long Version (MHI-LV)

Purpose: To measure the achievement of a medical home in primary care.

Format/Data Source: 25-item survey covering 6 domains: (1) organizational capacity, (2) chronic condition management, (3) care coordination, (4) community outreach, (5) data management, and (6) quality improvement. Responses are formatted based on a continuum from Level 1 to Level 4, which reflects the degree that a practice has achieved components of a medical home. An MHI score is calculated based on the responses to the 25 items.

Date: Measure published in 2003.¹

Perspective: System Representative(s)

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 2.4, 3.1
• Communicate:
  • Between health care professional(s) and patient/family: 1.2, 2.3, 2.4
  • Within teams of health care professionals: 2.3, 2.4
  • Across health care teams or settings: 2.3, 2.4
  • Participants not specified: 2.2
• Information transfer:
  • Between health care professional(s) and patient/family: 1.3, 2.3
  • Within teams of health care professionals: 2.3
  • Across health care teams or settings: 2.3
• Facilitate transitions:
  • Across settings: 2.3, 2.4
  • As coordination needs change: 2.5.1
• Assess needs and goals: 1.1, 1.4, 1.5, 3.1, 3.2, 3.4, 3.5
• Create a proactive plan of care: 2.2, 3.1, 3.4
• Support self-management goals: 3.3
• Link to community resources: 2.3, 2.6, 4.2
• Align resources with patient and population needs: 1.6, 2.6, 3.5, 3.6, 4.1
• Health care home: 1.1-6.2
• Care management: 2.4, 3.1, 3.5
• Health IT-enabled coordination: 5.1, 5.2

Development and Testing: The instrument was initially reviewed by a national panel of Medical Home experts. Subsequent testing revealed internal consistency, construct validity, and inter-rater reliability for the MHI in the assessment of primary care practices' implementation of the medical home concept. Psychometric analyses were based on data collected from survey administration in 43 pediatric primary care practices.¹

Link to Outcomes or Health System Characteristics: A study conducted across 43 primary care practices revealed that higher scores on the Medical Home Index and specifically higher subdomain scores for organizational capacity, care coordination, and chronic-condition management were associated with significant reductions in hospitalizations. Higher chronic-condition management scores were associated with lower emergency department use.²

Logic Model/Conceptual Framework: Medical Home Model.

Past or Validated Applications:

• Setting: Primary care pediatric or family medicine practices in the United States
• Population: Children with special health care needs (CSHCN)
• Level of evaluation: System; Practice

Notes:

• This instrument also has an available adult version. All questions are nearly identical except for minor wording changes to reflect adult care. Both the pediatric and adult versions can be found online.³
• This instrument is also available in a short version, which can be found online.³
• This instrument contains 25 items; all 25 were mapped.

Sources:

1. Cooley WC, McAllister JW, Sherrieb K, et al. The Medical Home Index: Development and validation of a new practice-level measure of implementation of the medical home. Ambul Pediatr 2003;3(4):173-80.
2. Cooley WC, McAllister JW, Sherrieb K, et al. Improved outcomes associated with medical home implementation in primary care. Pediatrics 2009;124(1):358-64.
3. Center for Medical Home Improvement (CMHI) Web site. Available at: http://www.medicalhomeimprovement.org/knowledge/practices.html#measurement. Accessed: 20 September 2010