Care Coordination Measures Atlas Project (Text Version)

Slide presentation from the AHRQ 2010 conference.

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

Slide 1

Care Coordination Measures Atlas Project

Care Coordination Measures Atlas Project

Kathryn McDonald
Stanford University
AHRQ Quality Indicators Project

Slide 2

Project Team

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

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

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

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

Results

Area

  • Definitions
  • Measurement Framework

Lessons Learned

  • 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

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

Measure Mapping Table

Care Coordination ActivitiesMeasurement Perspective
Patient/FamilyHealthcare Professional(s)System Representative(s)
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

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

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

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)
Current as of December 2010
Internet Citation: Care Coordination Measures Atlas Project (Text Version). December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2010/mcdonald/index.html