Chapter 5. Measure Maps and Profiles (continued, 8)

Measure #16b. Medical Home Index — Short Version (MHI-SV)

Care Coordination Measure Mapping Table

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

Medical Home Index — Short Version (MHI-SV)

Purpose: To be used as either: (1) an interval measurement in conjunction with the original MHI or (2) a quick “report card” or snapshot of practice quality. The Center for Medical Home Improvement (CMHI) recommends the use of the full MHI for practice improvement purposes and offers this short version for interval measurement and/or when it is not feasible to use the full MHI.

Format/Data Source: 10-item survey that scores a practice on a continuum of care across 3 levels that reflect the degree to which a practice has achieved components of a medical home.

Date: Measure released in 2006.¹

Perspective: System Representative(s)

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 7
• Communicate:
  • Between health care professional(s) and patient/family: 5
  • Within teams of health care professionals: 5
  • Across health care teams or settings: 5
  • Participants not specified: 4
• Facilitate transitions:
  • As coordination needs change: 6
• Assess needs and goals: 1, 8
• Create a proactive plan of care: 4, 7, 8
• Align resources with patient and population needs: 2, 9
• Health care home: 1-10
• Care management: 5, 7

Development and Testing: The short version did not undergo the same rigorous validation process as the long version, but it was arrived at through the same statistical process applied to the originally validated long version.¹

Link to Outcomes or Health System Characteristics: A study using the related Medical Home Index — Long Version showed that higher MHI scores were associated with reduced hospitalizations.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.²
• This instrument is also available in a long version, which can be found online.¹
• This instrument contains 10 items; all 10 were mapped.

Sources:
1. Center for Medical Home Improvement (CMHI) Web site. Available at: http://www.medicalhomeimprovement.org/knowledge/practices.html#measurement. Accessed: 20 September 2010
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.

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Measure #16c. Medical Home Family Index and Survey (MHFIS)

Care Coordination Measure Mapping Table

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

Medical Home Family Index and Survey (MHFIS)

Purpose: To provide a consumer report on practice performance, on the family experience of care, and detailed clinical, functional, satisfaction, and cost outcomes of child and family.

Format/Data Source: A 25-item Medical Family Home Index and a supplementary 47-item Family/Caregiver Survey. The index tracks to 3 of the 6 original MHI domains: (1) organizational capacity, (2) chronic condition management, and (3) care coordination.

Date: Measure released in 2005.¹

Perspective: Patient/Family

Measure Item Mapping:
(Index items are coded as I 1-25, and survey items are coded S 1-47)

• Establish accountability or negotiate responsibility: S 28, S 29, S 31-34, S 36
• Communicate:
  • Between health care professional(s) and patient/family: S 33
  • Across health care teams or settings: S 37
• Interpersonal communication:
  • Between health care professional(s) and patient/family: I 3-6
  • Participants not specified: I 11d
• Information transfer:
  • Between health care professional(s) and patient/family: I 7a, I 9, I 13, I 17a, S 34
  • Across health care teams or settings: I 12a, I 12b
• Facilitate transitions:
  • Across settings: I 11a
  • As coordination needs change: I 18
• Assess needs and goals: I 2c, I 2d, I 7b, I 7c, S 33
• Create a proactive plan of care: I 7a-d, I 8, I 19
• Monitor, follow up, and respond to change: I 7d, I 10a, I 10c, I 11a, S 37
• Support self-management goals: I 10b, S 28, S 29, S 31, S 32
• Link to community resources: I 10b, I 17a, I 16, S 37
• Align resources with patient and population needs: I 17a, I 11c
• Teamwork focused on coordination: I 19, S 21
• Health care home: I 1-25

Development and Testing: The development of the questions and language of the MHFIS involved the input of parents. The MHFIS is not a validated measure but was developed to serve as a companion to the validated MHI. It has been used in a study and was administered to a sample of 300 parents across 10 practices.²

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

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:

• All instrument items are located online.¹
• This instrument contains 72 items; 32 (25 index items, 7 survey items) were mapped.

Sources:
1. Center for Medical Home Improvement (CMHI) Web site. Available at: http://www.medicalhomeimprovement.org/knowledge/practices.html#measurement. Accessed: 20 September 2010
2. McAllister JW, Sherrieb K, Cooley CW. Improvement in the family-centered medical home enhances outcomes for children and youth with special healthcare needs. J Ambul Care Manage 2009;32(3):188-96.

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Measure #17a. Primary Care Assessment Tool — Child Expanded Edition (PCAT-CE)

Care Coordination Measure Mapping Table

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

Primary Care Assessment Tool — Child Expanded Edition (PCAT-CE)

Purpose: To measure pediatric care delivery from the patient/family perspective.

Format/Data Source: Community-based telephone survey (approximately 25 minutes in length). Survey responses are provided by children's parents and/or guardians. Some questions are designated as specifically related to care coordination. However, other items in other domains may be relevant to care coordination, although they are not explicitly categorized as measuring care coordination. Questions span 4 domains of primary care: (1) longitudinality, (2) accessibility, (3) comprehensiveness, and (4) coordination. Subtopics include: (A) affiliation with place/doctor, (B) first contact — utilization, (C) first contact — access, (D) ongoing care, (E) coordination, (F) coordination (information systems), (G) comprehensiveness (services available), (H) comprehensiveness (services provided), (I) family-centeredness, (J) community orientation, (K) culturally competent, (L) insurance questions, (M) health assessment, and (N) demographic/socioeconomic characteristics. Responses provided on a Likert scale.

Date: Measure published in 1998.¹

Perspective: Patient/Family

Measure Item Mapping:

• Establish accountability or negotiate responsibility: A3
• Communicate:
  • Between health care professional(s) and patient/family: E7
• Interpersonal communication:
  • Between health care professional(s) and patient/family: C4, D1-D4, D6, E8, E12
• Information transfer:
  • Between health care professional(s) and patient/family: E1, F1-F3, I2
  • Across health care teams or settings: E10, E11
  • Participants not specified: D10
• Facilitate transitions:
  • Across settings: B3, E6, E9
• Assess needs and goals: D7, D9, E8, I1
• Monitor, follow up, and respond to change: C8, E7, E11, E12
• Support self-management goals: G1-G15, G25, H1, H2, H 14-H18
• Align resources with patient and population needs: C1-C12, I3, J1
• Health care home: A1-A3, B1, B2, B4, D1
• Medication management: D13

Development and Testing: Adequate consistency, reliability, and construct validity established via psychometric testing of the survey on a sample of 450 parents/guardians of pediatric patients. The principal components factor analysis yielded 5 separate factors. These corresponded to the instrument's subdomains: first contact accessibility; coordination of care; characteristics of the professional-patient relationship over-time; comprehensiveness of services available; comprehensiveness of services received. Overall, psychometric assessment supported the adequacy of the PCAT-CE for assessing the characteristics/quality of primary care in pediatric settings.²

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

Logic Model/Conceptual Framework: Based on a framework of primary care.³

Past or Validated Applications:

• Setting: Primary care practices in the United States; adapted and translated for use in other countries (go to notes below)
• Population: Children (< 18 years) affiliated with primary care practices
• Level of evaluation: Health Care Professional(s); System

Notes:

• All instrument items are available online.¹
• This instrument contains 115 items; 86 were mapped.
• There are 4 expanded versions of this instrument addressing 4 perspectives: (1) child, (2) adult, (3) facility, and (4) physician. There are 4 short versions for each of the 4 perspectives as well.
• Versions of the PCAT tools are also available in Spanish, Catalan, Portuguese, Mandarin Chinese (both People's Republic of China and Taiwan), and Korean.¹
• The PCAT is in the process of being computerized, in administration as well as scoring, for widespread use around the world, including especially Southeast Asia, the Gulf States, several countries in Europe, South Africa, several countries in Latin America (especially Brazil and Uruguay), China and Hong Kong, and others. (B. Starfield, personal communication, September 8, 2010).
• For further information regarding these measures, please visit the Web site, which provides detailed instructions and implementation use.¹

Sources:

1. Johns Hopkins University Bloomberg School of Public Health. Available at: http://www.jhsph.edu/pcpc/pca_tools.html. Accessed: 20 September 2010.
2. Cassady, Starfield B, Hurtado MP, et al. Measuring consumer experiences with primary care. Pediatrics 2000;105:998-1003.
3. Starfield B. Primary care: concept, evaluation, and policy. New York: Oxford University Press; 1992.
4. Stevens GD, Shi LY. Racial and ethnic disparities in the quality of primary care for children. J Fam Pract 2002;51(6).

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Measure #17b. Primary Care Assessment Tool — Adult Expanded Edition (PCAT-AE)

Care Coordination Measure Mapping Table

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

Primary Care Assessment Tool —Adult Expanded Edition (PCAT-AE)

Purpose: To measure primary care quality and the extent to which it meets consumer needs, as identified from the adult patient perspective.

Format/Data Source: Mailed surveys taking approximately 40 minutes to complete. The validated PCAT-AE covers 5 primary care domains: (1) longitudinality, (2) first contact, (3) coordination, (4) comprehensiveness, and (5) derivative. Within the 5 domains are 7 scales: (1) first contact domain – accessibility, (2) first contact – utilization, (3) longitudinal domain – ongoing care, (4) coordination domain – coordination of services, (5) comprehensiveness domain – services available, (6) comprehensiveness domain – services received, (7) derivative domain –community orientation. Some questions are designated as specifically related to care coordination. However, other items in other domains may be relevant to care coordination, although they are not explicitly categorized as measuring care coordination. Responses provided on a Likert scale, and a total score was determined through the summation of values across the 5 primary care domains.

Date: Measure published in 2001.¹

Perspective: Patient/Family

Measure Item Mapping:

• Establish accountability or negotiate responsibility: A3
• Communicate:
  • Between health care professional(s) and patient/family: E7
• Interpersonal communication:
  • Between health care professional(s) and patient/family: C4, D1-D4, D6, E8, E12, I1
• Information transfer:
  • Between health care professional(s) and patient/family: E1, F1-F3, I2
  • Across health care teams or settings: E10, E11
  • Participants not specified: D10
• Facilitate transitions:
  • Across settings: B3, E6, E9
• Assess needs and goals: D7, D9, E8, I1
• Monitor, follow up, and respond to change: C8, E7, E11, E12
• Support self-management goals: G1-G15, G25, H1-H13
• Align resources with patient and population needs: C1-C12, I3, J1
• Health care home: A1-A3, B1, B2, D1
• Medication management: D13

Development and Testing: Factor and reliability analyses were conducted for all scales and domains, which were demonstrated to be both valid and reliable. Tests of Likert scaling assumptions (item-convergent validity, item-discriminant validity, equal item variance, equal item scale correlation, and score reliability) demonstrated that they were met. One-half of respondents reported the maximum score on the first-contact-utilization scale, indicating that a ceiling effect may be present for this scale; there was no evidence of a floor or ceiling effect for other scales. Tests of alpha coefficients and inter-factor correlations demonstrated that each primary care scale made a unique contribution to the instrument.¹

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

Logic Model/Conceptual Framework: Based on a framework of primary care.²

Past or Validated Applications:

• Setting: Primary care practices in the United States; adapted and translated for use in other countries (go to notes below)
• Population: Adult primary care patients
• Level of evaluation: Health Care Professional(s); System

Notes:

• All instrument items are available online.³
• This instrument contains 131 items; 80 were mapped.
• There are 4 expanded versions of this instrument addressing 4 perspectives: (1) child, (2) adult, (3) facility, and (4) physician. There are 4 short versions for each of the 4 perspectives as well.
• Versions of the PCAT tools are also available in Spanish, Catalan, Portuguese, Mandarin Chinese (both People's Republic of China and Taiwan), and Korean.³
• The PCAT is in the process of being computerized, in administration as well as scoring, for widespread use around the world, including especially Southeast Asia, the Gulf States, several countries in Europe, South Africa, several countries in Latin America (especially Brazil and Uruguay), China and Hong Kong, and others. (B. Starfield, personal communication, September 8, 2010).
• For further information regarding these measures, please visit the Web site, which provides detailed instructions and implementation use.³

Sources:

1. Shi LY, Starfield BH, Xu J. Validating the Adult Primary Care Assessment Tool. J Fam Pract 2001;50:161.
2. Starfield B. Primary care: concept, evaluation, and policy. New York: Oxford University Press; 1992.
3. Johns Hopkins University Bloomberg School of Public Health. Available at: http://www.jhsph.edu/pcpc/pca_tools.html. Accessed: 20 September 2010.
4. Shi LY, Starfield BH, Xu J, et al. Primary care quality: Community health center and health maintenance organization. South Med J 2003;96(8):787-95.