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Care Coordination Accountability Measures for Primary Care Practice

Care Coordination Accountability Measures for Primary Care Practice

Care Coordination Accountability Measures for Primary Care Practice

We recommend the following measures for evaluating primary care practices for accountability or recognition purposes (Table 1). We identified measures separately for application to pediatric and adult primary care settings. All measures contained in this set are from the patient/family perspective.

Pediatric Measure: Primary Care Assessment Tool—Child Edition (PCAT-CE)

Atlas Measure Number: 17aii

Description: This measure surveys parents and guardians about pediatric care delivery for their children. The 115-item survey takes approximately 25 minutes to administer by telephone. The survey may also be administered through self-assessment, although no information is available on typical completion times using this method. The survey covers many aspects of pediatric primary care including but not limited to care coordination. Testing has established its reliability and validity; however, no information is available about how the measure score relates to outcomes.2

Strengths for Accountability Purposes: The measure was designed for accountability purposes and has established reliability and validity. In addition to the measure's total score, sub-scale scores may be calculated for care coordination and coordination related to information systems, which may be useful when interpreting results. The measure covers all Atlas activity domains and sub-domains except Facilitate Transitions as Coordination Needs Change, Create a Proactive Plan of Care, and Link to Community Resources.

Weaknesses for Accountability Purposes: The measure's focus extends beyond care coordination to include many aspects of pediatric primary care (29 of 115 measure items do not map to any Atlas care coordination activity domain). Inclusion of additional primary care concepts should be considered when interpreting the total measure score for the purposes of care coordination assessment. Although the instrument was designed for accountability purposes, all published instances of use identified to date were for research purposes.3-5

For More Information: Additional information about the measure properties is summarized in the Care Coordination Measures Atlas measure profile and in Appendix C of this document. A copy of the measure instrument and user guide may be obtained by contacting the measure developer. Contact information is available in Appendix IV of the Atlas.

Alternative Pediatric Measure: Family-Centered Care Self-Assessment Tool—Family Version

If a focus on care coordination is of higher interest than reliability or validity, then users may consider the Family-Centered Care Self-Assessment Tool—Family Version as an alternative to the PCAT-CE. Although noreliability or validity testing for this instrument, was identified, all but 8 of its 98 items relate to care coordination and it covers all but one Atlas care coordination activity domain.

Atlas Measure Number: 11a

Description: This measure surveys parents or other family members about the provision of family-centered pediatric care. No information is available on typical completion times for the 98-item self-assessment instrument. No reliability or validity testing has been reported among the sources identified. Due to lack of psychometric testing, the measure developers do not recommend combining responses across items to develop mean or aggregate scores for groups of conceptually-related instrument items. Rather, they recommend reporting percent responses to individual items only. Therefore, while the instrument should be administered as a whole, responses on items most relevant to care coordination may be reported separately.6,7

Strengths for Accountability Purposes: Nearly all measure items (92%) map to an Atlas care coordination activity domain and the measure covers all Atlas activity domains and sub-domains except Facilitate Transitions Across Settings.

Weaknesses for Accountability Purposes: The measure was designed for quality improvement rather than accountability purposes and no information is available on its validity or reliability.

For More Information: Additional information on the measure properties is summarized in the Atlas measure profile as well as in Appendix C of this document. A copy of the measure instrument may be obtained by visiting the Care Coordination Measures Atlas Appendix IV. A user guide may be obtained by contacting the measure developer; however, to use the measure, written permission must be provided by the measure developer. Contact information is available in Appendix IV of the Atlas.

Adult Measure: Client Perceptions of Coordination Questionnaire (CPCQ)

Atlas Measure Number: 6

Description: This measure surveys patients about patient-centered care and care coordination. The instrument contains 31 items; no information is available on typical completion times for this self-administered survey. Although the overall reliability score was very high, the measure developers note concerns about reliability of two sub-scales included in the instrument. Thus, results are reported for individual items in the instrument rather than calculating total or sub-scale scores. Validity has been established through comparison of various test groups. Patients expected to experience similar levels of coordination (participants in a coordination trial and the general population) did so, while those expected to experience lower levels of coordination (patients with chronic pain) reported lower CPCQ scores than trial participants.8 For more information about validity and reliability, refer to the Atlas measure profile and Appendix C.

Strengths for Accountability Purposes: Validity is established and overall reliability is strong. Although no information is available on typical completion times, the brevity of the instrument suggests lower measurement burden on patients than alternative measures. The measure is designed to focus on care coordination (23 of 31 items map to an Atlas care coordination domain) and covers all Atlas activity domains except Facilitate Transitions (both sub-domains), and Link to Community Resources. Additional items cover concepts related to care access and satisfaction by additional members involved in the care process.

Weaknesses for Accountability Purposes: Developers note some concerns about reliability of selected items related to 'client comprehension and capacity'. The measure has been used for research, but no information was available about use for accountability purposes. No items map to Facilitate Transitions (either sub-domain). Most Atlas activity domains are covered by only one or two instrument items, although this partially reflects the brevity of the instrument.

For More Information: Additional information on the measure properties is summarized in the Atlas measure profile and Appendix C of this document. Prior to use of the measure written permission is required by the measure developer. A copy of the measure and contact information are available in Appendix IV of the Atlas.

Alternative Adult Measure: Primary Care Assessment Tool—Adult Edition (PCAT—AE)

If coordination related to transitions across settings is of particular interest, the Primary Care Assessment Tool—Adult Edition (PCAT-AE) may be an alternative to the CPCQ. The PCAT-AE includes three items that map to the Transitions Across Settings sub-domain, whereas the CPCQ does not measure coordination related to transitions of care. The PCAT-AE may also be of interest if consistency with measurement in a pediatric population is desired, as the PCAT-AE is based on the very similar Child Edition of the Primary Care Assessment Tool, which is recommended as the pediatric primary care practice accountability measure. However, the validity of the PCAT-AE is less well established than that of the CPCQ.

Atlas Measure Number: 17b

Description: This measure surveys patients about the quality of primary care. The 131-item survey reportedly takes approximately 40 minutes to complete. The survey may be administered by an interviewer (by telephone or in person) or through self-assessment, although the measure developers note that a high school reading level is required for self-assessment. The survey covers many aspects of primary care, including but not limited to care coordination. Testing has established its reliability and factor analyses provide some preliminary information on validity, although no information is available about how the measure score relates to outcomes.9

Strengths for Accountability Purposes: The measure was designed for accountability purposes and has established reliability. It is related to the child edition of the PCAT. In addition to the measure's total score, sub-scale scores may be calculated for care coordination and coordination related to information systems, which may be useful when interpreting results. The measure covers all Atlas activity domains and sub-domains except Facilitate Transitions as Coordination Needs Change, Create a Proactive Plan of Care, and Link to Community Resources.

Weaknesses for Accountability Purposes: Validity of the measure is not well established. The measure's focus extends beyond care coordination to include many aspects of primary care (51 of 131 measure items do not map to any Atlas care coordination activity domain). Inclusion of additional primary care concepts should be considered when interpreting the total measure score for the purposes of care coordination assessment. Although the instrument was designed for accountability purposes, all published instances of use identified to date were for research.10

For More Information: More information on the measure properties is summarized in the Atlas measure profile and Appendix C of this report. A copy of the measure and user guide may be obtained from the developer. Contact information is available in Appendix IV of the Atlas.

Table 2 summarizes recommendations for the Care Coordination Accountability Measure Set for Primary Care Practice.


ii. Throughout this document, measure numbers refer to numbering used in the Care Coordination Measures Atlas (available for download at http://www.ahrq.gov/qual/careatlas/index.html).


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Page last reviewed January 2012
Internet Citation: Care Coordination Accountability Measures for Primary Care Practice: Care Coordination Accountability Measures for Primary Care Practice. January 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/pcpaccountability/pcpacc1.html