Potential Measures for Clinical-Community Relationships
A promising approach to enhancing the delivery of preventive services in clinical settings is for providers to coordinate, cooperate, and collaborate with community-based organizations to help deliver these services. The Agency for Healthcare Research and Quality (AHRQ) refers to this collaborative approach to the delivery of preventive services as clinical-community relationships.
AHRQ is conducting foundational measure development activities to help improve evaluation, research, and practice in the area of clinical-community relationships for prevention. The project has included developing the Clinical-Community Relationship Measures (CCRM) Atlas of existing measures of clinical-community relationships1 and an Evaluation Roadmap2 to guide research on clinical-community relationship processes and outcomes.
The Atlas provides a list of existing measures for assessing the structures, processes, and outcomes associated with clinical-community relationships for prevention. The measures are organized according to a measurement framework guided by the relationships between clinicians, patients and community resources. While the framework has 56 domains, the literature search on which the Atlas was based found no existing measures in 46 of those domains. The Atlas includes 22 measures covering 10 domains.
In this supplemental report, the investigators suggest 52 potential measures or measurement concepts that could be developed to fill the gap in measurements for those 46 domains. Broader delivery system and community factors not included here may be relevant to measure in some situations.
The measurement framework for organizing the measures is summarized in Appendix Table A-1. Definitions for each domain in the framework can be found in Appendix Table A-2. More details on the framework and the domains can be found in the Atlas. For ease of reference, we also include in this report the 22 existing measures included in the Atlas. These are listed in Appendix Table A-3 and shown in detail in Appendix Tables A-4 through A-25.
This report also proposes a core set of 13 measures culled from both the existing measures in the Atlas and the potential measures in this report, that represent the essential aspects of clinical community relationships for prevention. The core set reflects a judgment about which measures may be the most useful and feasible for quality improvement and program evaluation. These measures are suggested for further testing and development to refine their specifications and assess their usefulness for improving process, with the ultimate aim of increasing the delivery of appropriate clinical preventive services. The core set responds to the need for measures that are broadly applicable across settings and programs, while focusing on key aspects of the structures, processes, and outcomes that are important for any type of clinical-community relationship design. Many of the measures may also be applicable for broader use in assessing and improving clinical-community relationships for a wider set of services or activities beyond the specific clinical preventive services that have been the focus of this project.
This report explains the investigators’ approach for developing the potential measures, with important limitations, and presents the potential measures using a standardized template. The report concludes with a discussion of the core measures and next steps.
1. Clinical-Community Relationships Measures (CCRM) Atlas. March 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/resources/clinical-community-relationships-measures-atlas/index.html.
2. Clinical-Community Relationships Evaluation Roadmap. July 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/resources/clinical-community-relationships-eval-roadmap/index.html