Potential Measures for Clinical-Community Relationships

A Supplement to the Clinical-Community Relationships Atlas

Community Resource Element: Clinic/Clinician-Patient Relationship

Potential Measure DD
ItemDescription
TitleClinic/clinician efficiency due to the use of clinical-community relationships
DescriptionThis measure assesses the time savings clinicians experience by referring patients to a community resource(s) for selected preventive services compared to providing those services within the clinic.
DomainCost/efficiency (clinic/clinician-patient)
Data sourceClinic/clinician survey
Calculation methodThis measure will report the total time savings a clinic reports in referring patients to community resources for selected preventive services compared to providing the service within the clinic.
NotesEfficiency may be determined by evaluating referral time, actual time to administer services, etc.

Clinic/clinician administrative data may serve as supplementary data sources for this measure.

Clinicians may not have the time to deliver all recommended clinical preventive services given reimbursement limitations for office visits. Clinical-community relationships have the potential to save clinicians time while ensuring that recommended services are delivered.
Potential Measure EE
ItemDescription
TitlePercentage of patients who received appropriate preventive services
DescriptionThis measure assesses whether patients are receiving appropriate preventive services (delivered either by the clinician or by a community resource), focusing on services suitable for delivery by a community resource.
DomainDelivery of service (clinic/clinician-patient)
Data sourcePatient survey – Patients may be the most reliable reporters of the receipt of preventive services, especially counseling services.
Calculation methodThis measure will report the percentage of patients who received each applicable preventive service as well as the percentage of patients who receive all applicable preventive services. This measure may focus on patients of a particular primary care practice or on a representative sample of patients from the community as a whole.
NotesThe meaning of “appropriate” received preventive services depends on context, setting, and the particular evaluation goals of any study that uses the measure.

 

Potential Measure FF
ItemDescription
TitlePatient-centeredness of care offered by clinic/clinicians
DescriptionThis measure assesses the level of patient-centeredness of the services patients receive from clinic/clinicians.
DomainPatient-centeredness (clinic/clinician-patient)
Data sourcePatient/individual survey
Calculation methodThis measure may be reported for patients of a particular primary care clinic or for primary care patients in the community as a whole. It may be targeted to patients participating in a clinical-community relationship or be reported more generally. The measure will be reported as the average level of patient-centeredness of the care received from clinic/clinicians in a community. Subscale domains for this measure may include levels of the following: enabling of informed decisions, coordination of care, and patient value reflected in care.
NotesPrinciples of the measure may be adapted from work by CAHPS Patient Centered Medical Home survey:
https://www.cahps.ahrq.gov/surveys-guidance/cg/pcmh/index.html

Similar to measure WW in patient-community resource relationship
Potential Measure GG
ItemDescription
TitlePatient experience of care with primary care clinic/clinician
DescriptionThis measure assesses aspects of a patient’s experience with a clinic/clinician to achieve a desired preventive health goal.
DomainPatient experience (clinic/clinician-patient)
Data sourcePatient/individual survey
Calculation methodThis measure may be reported for patients of a particular primary care clinic or for primary care patients in the community as a whole. This measure may be based on specific survey items (patient recall of interactions with clinic/clinician, experience with treatment, etc.) or may be reported as a composite measure  that combines responses to several survey items to assess relevant aspects of patient experience.
NotesThis measure may focus on preventive services amenable to the clinical-community relationships approach to support a comparison between the delivery of these services in the clinical setting and the community setting.

Similar to measure XX of patient-community resource relationship
Potential Measure HH
ItemDescription
TitleClinician supports patient self-management of prevention
DescriptionThis measure assesses clinician support for patient self-management of prevention activities.
DomainSelf-management support (clinic/clinician-patient)
Data sourcePatient/individual survey
Calculation methodThis measure may be reported for patients of a particular clinical practice or for patients in the community as a whole. It may be targeted to patients participating in a clinical-community relationship or be reported more generally. This measure may report the percentage of patients who report clinician support of self-management for prevention. Support may include clinician involvement in the development, implementation, and monitoring of a prevention plan and the encouragement of patients to use self-support groups, programs, or tools.
NotesPrinciples for this measure may be adapted from Canadian Institute for Health Information: Self-management support indicator: https://secure.cihi.ca/free_products/Pan-Canadian_PHC_Indicator_Update_Report_en_web.pdf

Measure principles may also be adapted from IHI self-management support measures:
http://www.ihi.org/knowledge/Pages/Measures/SelfManagementSupportMeasures.aspx

This measure is most relevant in the context of a clinical-community relationship.

Similar to measure ZZ of the patient-community resource relationship.
Potential Measure II
ItemDescription
TitlePatient report of shared decision making regarding prevention
DescriptionThis measure assesses the patient’s perception of the level of shared decision-making regarding prevention as reflected in perceived information sharing, and the incorporation of patient preferences and values in the delivery of preventive services.
DomainShared decision-making (clinic/clinician-patient)
Data sourcePatient/individual survey
Calculation methodThis measure may be reported as the average level of shared decision making between a patient and a particular clinician/clinical practice.
NotesPrinciples for the measure may be adapted from the Partnership Self-Assessment Tool: http://www.lmgforhealth.org/node/190

This measure is most relevant in the context of a clinical-community relationship.
Current as of October 2013
Internet Citation: Potential Measures for Clinical-Community Relationships: A Supplement to the Clinical-Community Relationships Atlas. October 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/prevention-chronic-care/resources/ccrm-atlas-suppl/ccrm-atlas3-4.html