Potential Measures for Clinical-Community Relationships
The Agency for Healthcare Research and Quality (AHRQ) has set a long-term goal of understanding whether fostering relationships between clinical practices and community organizations is an effective and feasible way to enhance the delivery of specific clinical preventive services. AHRQ’s Clinical-Community Relationships Measures (CCRM) Atlas, published in March 2013, 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. The framework has 56 domains; however, the literature search on which the Atlas was based found no existing measures in 46 of those domains. The search uncovered 22 measures in 10 domains.
In this supplement, the investigators suggest 52 potential measures or measurement concepts that could be developed to fill the gaps in measurements for those domains. Measures outside the domains in the framework are not included, although broader delivery system and community factors beyond the framework may be relevant to measure in some situations.
This report also proposes a core set of 13 measures, culled from both the existing measures in the Atlas and the potential measures here 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.
The 52 potential measures can provide a starting point for future measure development and refinement work in the context of specific program implementation efforts, quality improvement initiatives, or program evaluations. (The 13 measures in the core set are particularly promising in this regard.) In some cases it has proved difficult to provide detailed potential measure specifications in the absence of information about the specific program being assessed or the anticipated uses of the measurement data. The investigators provide as much detail as possible in the potential measure definitions, but these definitions should be viewed as concepts for future measure development, testing, and adaptation rather than final specifications. Many of these measures may also be applicable for broader use in assessing clinical-community relationships for a wider set of services or activities than the specific clinical preventive services that have been the focus of this project.