CARE COORDINATION MEASURES ATLAS PROJECTKathryn McDonald

Stanford Health Policy

AHRQ Quality Indicators Project

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

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

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

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

Area Lessons Learned

Results

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)

Definitions

Measurement Framework

COORDINATIONEFFECTS

MECHANISMSMeans of achieving goal

Coordination ActivitiesActions hypothesized to support coordination. Not necessarily executed in structured way.

COORDINATION MEASURES

Experienced in different ways depending upon the perspective

Patient/Family Perspective

Healthcare Professional Perspective

System Representative

Perspective

Broad ApproachesCommonly used groups of activities and/or tools hypothesized to support coordination.

GOAL: COORDINATED CARE

Context: Settings; Patient Populations; Timeframe; Facilitators; Barriers

Measure Mapping TableMEASUREMENT PERSPECTIVE

Patient/Family Healthcare Professional(s)

SystemRepresentative(s)

CARE COORDINATION ACTIVITIESEstablish accountability or negotiate responsibility Communicate

Interpersonal Communication Information Transfer

Facilitate transitionsAcross settings

As coordination needs changeAssess 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 COORDINATIONTeamwork focused on coordination Healthcare Home Care ManagementMedication ManagementHealth IT-enabled coordination

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

Measure Mapping and Profile See 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

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)