Chapter 5. Measure Maps and Profiles (continued, 2)

Care Coordination Measures Atlas

Measure #1. Assessment of Chronic Illness Care (ACIC)

Care Coordination Measure Mapping Table

 Measurement Perspective:
Patient/FamilyHealth Care
Professional(s)
System
Representative(s)
Care Coordination Activities
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  ■*
Health care home   
Care management   
Medication management   
Health IT-enabled coordination  

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items
*The use of a filled square for this measure indicates that it is a composite score.

Assessment of Chronic Illness Care (ACIC)

Purpose: To evaluate the quality-improvement-related strengths and weaknesses of care delivery for chronic illness.

Format/Data Source: Version 3.5 is a 34-item survey that covers 6 areas: (1) community linkages, (2) self-management support, (3) decision support, (4) delivery system design, (5) information systems, and (6) organization of care. Questions are divided by area of focus (6 areas of chronic illness care) and responses are in the form of a rating scale (Levels A-D).

Date: Measure released in 2000.1

Perspective: System Representative(s)

Measure Item Mapping:

  • Establish accountability or negotiate responsibility: 18, 19
  • Communicate:
    • Across health care teams or settings: 15, 23
  • Information transfer:
    • Between health care professional(s) and patient/family: 17, 29
    • Participants not specified: 27
  • Assess needs and goals: 10, 30, 33
  • Create a proactive plan of care: 28
  • Monitor, follow up, and respond to change: 20-22, 25, 33
  • Support self-management goals: 10-13, 30, 34
  • Link to community resources: 7, 8, 31
  • Align resources with patient and population needs: 9, 16, 32
  • Teamwork focused on coordination: 18, composite score
  • Health IT-enabled coordination: 24-26, 30

Development and Testing: Instrument development was based on areas of system change suggested by the Chronic Care Model (CCM) that have been shown to influence quality of care. The instrument was tested in 108 organizational teams implementing 13-month long quality-improvement collaboratives in health care systems across the U.S. Paired t-tests were used to evaluate the sensitivity of the ACIC to detect system improvements. Testing revealed that all six subscale scores were responsive to system improvements made by care teams. In addition, a significant positive relationship between differences in self-reported ACIC scores and a RAND measure of the presence of chronic care model components in care program implementation was found.2

Link to Outcomes or Health System Characteristics: Moderately strong and positive Pearson correlations were found between ACIC scores and observational ratings of chronic care outcomes made by faculty from each collaborative program, with the exception of the community linkages subscale. Faculty ratings were based on team-prepared cumulative monthly reports, which included process and outcomes data (e.g., chart review data).2 Another study found that, controlling for patient and clinic characteristics, a 1-point increase in the ACIC score was associated with a 16 percent relative decrease in risk for coronary heart disease attributable to modifiable risk factors.3 Another study found that characteristics of the primary care clinic where a patient receives care, as measured by the ACIC, are an important predictor of glucose control.4

Logic Model/Conceptual Framework: Chronic Care Model.

Past or Validated Applications:

  • Setting: Health systems with chronic care teams in the United States
  • Population: Patients with chronic disease
  • Level of evaluation: System

Notes:

  • All instrument items are located online.1
  • This instrument contains 34 items; 25 were mapped.
  • Spanish, Thai, German, and Hebrew translations are available online.1

Sources:

1. Improving Chronic Illness Care Web site. Available at: http://www.improvingchroniccare.org/index.php?p=Versions&s=297. Accessed: 23 September 2010.
3. Bonomi AE, Wagner EH, Glasgow RE, et al. Assessment of Chronic Illness Care (ACIC): A practical tool to measure quality improvement. Health Serv Res 2002;37(3):791-820.
3. Parchman ML, Zeber JE, Romero RR, et al. Risk of coronary artery disease in type 2 diabetes and the delivery of care consistent with the chronic care model in primary care settings: A STARNet study. Med Care 2007;45(12):1129-34.
4. Parchman ML, Pugh JA, Wang CP, et al. Glucose control, self-care behaviors, and the presence of the chronic care model in primary care clinics. Diabetes Care 2007;30(11):2849-54.
5. Solberg LI, Crain AL, Sperl-Hillen JM, et al. Care quality and implementation of the chronic care model: A quantitative study. Ann Fam Med 2006;4(4):310-16.
6. Sunaert P, Bastiaens H, Feyen L, et al. Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: The Belgian experience. Health Serv Res 2009;9(152).

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Measure #2. ACOVE-2 Quality Indicators — Continuity and Coordination of Care Coordination

Care Coordination Measure Mapping Table

 Measurement Perspective:
Patient/FamilyHealth Care
Professional(s)
System
Representative(s)
Care Coordination Activities
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   
Health care home  
Care management   
Medication management  
Health IT-enabled coordination   

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

ACOVE-2 Quality Indicators — Continuity and Coordination of Care

Purpose: To assess the quality of care related to coordination and continuity for vulnerable elders at the health-system level across all health conditions and diagnoses.

Format/Data Source: 13 quality indicators from the ACOVE-2 set, specific to care coordination and continuity. Information is obtained from medical records and administrative data.

Date: Measure released in 2001.1

Perspective: System Representative(s)

Measure Item Mapping:

  • Establish accountability or negotiate responsibility: 1
  • Communicate:
    • Information transfer
      • Across health care teams or settings: 4, 5, 8, 11, 12
  • Monitor, follow up, and respond to change: 2, 5, 6, 8-10
  • Align resources with patient and population needs: 13
  • Health care home: 1
  • Medication management: 2, 3, 7

Development and Testing: Indicators were developed based on literature review and expert panel consultation. Fifteen initial indicators were reviewed by independent panels of experts to assess validity and feasibility using a variation of the RAND/UCLA Appropriateness Method for developing guidelines to measure the appropriateness of medical care. Thirteen indicators were ultimately found to be valid. They were further evaluated by the American College of Physicians American Society of Internal Medicine Aging Task Force before publication.2

Link to Outcomes or Health System Characteristics: Supporting evidence, mostly from observational studies, supports the linkage between these quality indicators and improved patient health outcomes. For example, several studies cited in Wenger (2004) demonstrate an association between the discharge planning and comprehensive followup activities outlined in the ACOVE indicators and reduced hospital readmissions and costs of care.2

Logic Model/Conceptual Framework: None described in the sources identified.

Past or Validated Applications:

  • Setting: Not specific
  • Population: Vulnerable elders
  • Level of evaluation: System

Notes:

  • All instrument items are located online.1
  • This instrument contains 13 items; all 13 were mapped.

Source(s):

1. RAND Health Project: Assessing Care of Vulnerable Elders Web site. Available at: http://www.rand.org/health/projects/acove/acove2/. Accessed: 21 September 2010.
2. Wenger NS, Young RT. Quality indicators for continuity and coordination of care in vulnerable elders. JAGS 2007;55(S2):S285-S292.

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Measure #3. Coleman Measures of Care Coordination

Care Coordination Measure Mapping Table

 Measurement Perspective:
Patient/FamilyHealth Care
Professional(s)
System
Representative(s)
Care Coordination Activities
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   
Health care home  
Care management   
Medication management  
Health IT-enabled coordination   

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

Coleman Measures of Care Coordination

Purpose: To measure coordination of care post hospital discharge as part of an evaluation of the association between care coordination and use of the Emergency Department (ED) in elderly patients.

Format/Data Source: Measures of care coordination constructed from data found in a self-reported health status survey, a telephone survey, and health plan utilization and pharmacy administrative data. The following information was collected from administrative data: (1) number of physicians involved with care, (2) number of prescribers involved with care, (3) percent of changes in 1 or more chronic disease medications that resulted in a followup visit within 28 days, (4) percent of missed ambulatory encounters that resulted in a followup visit within 28 days, (5) percent of same day ambulatory encounters that resulted in a followup visit within 28 days.

Date: Measure released in 2002.1

Perspective: System Representative(s); survey items from Patient/Family perspective

Measure Item Mapping:

  • Establish accountability or negotiate responsibility: 1b
  • Communicate:
    • Across health care teams or settings: 1f
    • Interpersonal communication:
      • Between health care professional(s) and patient/family: 1i
    • Information transfer:
      • Between health care professional(s) and patient/family: 1e
      • Across health care teams or settings: 1g
      • Participants not specified: 1j
  • Assess needs and goals: 1k
  • Monitor, follow up, and respond to change: 4-6, 1a, 1c, 1d
  • Health care home: 2
  • Medication management: 3, 4

Development and Testing: Telephone-based survey utilized validated scales of the Components of Primary Care Index (CPCI) measure developed by Flocke.2 Relevant administrative data measures were selected based on the evidence-based hypothesis that followup care would be particularly important post-discharge, when patients might be at increased risk for subsequent adverse events (urgent ambulatory visits, missed appointments, or medication changes). Two of the administrative data measures used have been utilized in other studies.3-4 Correlations between self-report and administrative-data-derived care coordination measures were examined, and the Person correlations ranged from 0.00 to 0.28, suggesting that the two types of measures were likely measuring distinct aspects of care coordination.

Link to Outcomes or Health System Characteristics: This multi-component measure was used to measure the impact of care coordination on inappropriate emergency department (ED) use in older managed care enrollees with multiple chronic conditions. The measure was not found to be associated with inappropriate ED use in this study population. The study authors suggest that this may, in part, be due to the inability to adequately distinguish the role of care coordination from other potential factors that influence utilization.1

Logic Model/Conceptual Framework: None described in the sources identified.

Past or Validated Applications:

  • Setting: Care management program of a large group-model HMO in the United States
  • Population: Elderly patients with multiple chronic diseases
  • Level of evaluation: System

Notes:

  • The original measure did not have individual items numbered. In order to properly reference specific items within this profile, we consecutively numbered all measure items with a care coordination construct found in Table 1 of the source article.1 Additionally, all question items included in Measure 1 (Care Coordination Telephone Survey) found in Appendix 1 were labeled 1a-1m.
  • This instrument contains 18 items; 15 were mapped

Source(s):

1. Coleman EA, Eilertsen TB, Magid DJ, et al. The association between care coordination and emergency department use in older managed care enrollees. Int J Integr Care 2002;2:1-11.
2. Flocke SA. Measuring attributes of primary care: development of a new instrument. J Fam Pract 1997;45(1):64-75.
3. Roblin DW, Juhn PI, Preston BJ, et al. A low-cost approach to prospective identification of impending high cost outcomes. Med Care 1999;37(11):1155-63.
4. Chapko MK, Fisher ES, Welch HG. When should this patient be seen again? Eff Clin Pract 1999;2(1):37-43.

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Current as of January 2011
Internet Citation: Chapter 5. Measure Maps and Profiles (continued, 2): Care Coordination Measures Atlas. January 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/coordination/atlas/chapter5a.html