Potential Measures for Clinical-Community Relationships

A-2. Measurement framework domains and definitions

Appendix Table A-2. Measurement  framework domains and definitions

Domain Definition
Ability to access primary care The degree to which a patient has or perceives that he or she has the ability to access primary care services
Ability to access the community resource The degree to which a patient has or perceives that he/she has the ability to access the community resource
Accessibility The degree to which the attributes of the clinic/clinician or the community resource affect how accessible its services are (e.g., open scheduling and open hours)
Assessment and goal setting The degree of interaction between a clinic/clinician or referred community resource and a patient to develop a plan of action for preventive services
Capacity for self-management The degree of environmental support that a patient has for his or her health management, which could include family, community, psychological, and social support
Clinician experience The level of utility from a clinic/clinician’s perspective of participation in the clinical-community resource relationship
Communication and follow- through/follow-up The level of interaction between a community-based resource and patient after the initial connection between them
Community resource experience The level of utility from a community resource’s perspective of participation in the clinical-community resource relationship
Cost/efficiency The amount of resources, time, energy, and productivity associated with the provision of the services and activities connected with the relationship
Delivery of service The rate of completion or receipt of services
Delivery system design The scope of professional services provided and how those services are provided by a clinic/clinician and/or community resource (i.e., this domain contains measures of the presence or degree to which certain professional services exist as well as measures of the methods of providing such services)
Feedback and communication The level and means of communication between the community resource and the clinic/clinician
Health literacy The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
Information technology infrastructure The degree of availability and use of relevant aspects of information technology within a clinic/clinician organization, patient, or community resource
Informed and activated patient The level of trust and increase in level of information a patient has (or is perceived to have) for participating in a relationship
Knowledge of and familiarity with community resources The clinician’s and/or patient’s degree of awareness of the availability, range of services, level of cultural competency, and quality of services provided by various community resources
Marketing of services The level of action and effort taken by a community resource to share information with clinics/clinicians and patients about the availability and types of preventive services provided
Marketing results The results of marketing activities that a community resource could be engaging in
Nature and strength of the inter-organizational relationship The level of intensity of a relationship between a clinic/clinician and community resource (based on Himmelman’s definitions of networking, coordinating, cooperating, or collaborating). This includes the degree to which the relationship can overcome common barriers of working together— time, trust, and turf (Himmelman, 2002).
Organizational infrastructure The way in which a clinic/clinician and/or community resource organizes the people and office process components of its business; the degree to which it is supported by a sustainable business model and governance structure (i.e., this domain contains measures of the presence or degree to which such organizational infrastructure exists)
Outreach to obtain knowledge of and familiarity with community resources The level of action and effort taken by a clinic/clinician or patient to learn about the availability of community resources and the services provided
Patient-centeredness The degree to which attributes of whole-person care, family-centered care, respectfulness, cultural sensitivity, and advocacy for a patient exist
Patient experience The level of utility from a patient’s perspective of participation in the clinician-patient or patient-community resource relationship
Proactive and ready clinician The level of involvement a clinician provides in a clinical-patient relationship
Proactive and ready community resource The level of involvement a community-based resource provides in a patient-community resource relationship
Readiness for behavior change The level and/or type of activity that a clinic/clinician, patient, or community resource engages in to prepare for behavioral change that might be affected by a referral to a community resource
Referral process Data (e.g., frequency) related to the process of developing, obtaining, and confirming a referral among all of the relationships
Self-management support The level of interaction between the clinician or community resource and the patient aimed at helping patients stay informed about recommended clinical preventive services, and overcoming any barriers to the receipt of services that would prevent them from being active participants in their own care
Service capacity The level of capacity, including amount of staff, resources, etc. that a clinic/clinician and/or community resource has to provide preventive services as well as manage the relationship(s)
Shared decision-making The level of clinician-patient information sharing regarding the preventive health services being addressed and the level of patient expression of his or her preferences and values
Stage of behavior change The level, movement, or degree of sustainability achieved by a clinic/clinician, patient, and/or community resource among the various stages of readiness for behavioral change (i.e., pre-contemplation, contemplation, preparation, action, and maintenance)
Timeliness The amount of time it takes for clinical preventive services to be delivered when clinicians make referrals to community resources
Training The level of education and/or competency of individuals within a clinic/clinician and/or community resource to provide preventive services
Page last reviewed October 2013
Internet Citation: A-2. Measurement framework domains and definitions. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/resources/ccrm-atlas-suppl/ccrm-apptaba-2.html