Chartbook on Care Coordination
Trends in Care Coordination Measures
- Only 37 Care Coordination measures could be tracked over time.
- Eighteen showed improving quality.
- Six showed worsening quality.
- The remaining 13 showed no change.
- One measure improved quickly (average annual rate of change >10% per year):
- Hospital patients with heart failure who were given complete written discharge instructions.
Care Coordination Vision
The vision is health care providers, patients, and caregivers all working together to "ensure that the patient gets the care and support he needs and wants, when and how he needs and wants it" (NQS, 2011).
Care Coordination Benefits
Conscious, patient-centered coordination of care improves the person's experience and leads to better long-term health outcomes, as demonstrated by fewer unnecessary hospitalizations, repeated tests, and conflicting prescriptions, as well as clearer discourse between providers and patients about the best course of treatment (NQS, 2013).
Provider Communication and Care Coordination
- Six essential elements of provider-patient communication include:
- Having open discussion.
- Gathering information.
- Understanding the patient’s perspective.
- Sharing information.
- Reaching agreement on problems and plans.
- Providing closure (Dean, et al., 2014).
Measures of Care Coordination
- Transitions of care.
- Preventable emergency department visits.
- Potentially avoidable hospitalizations.
- Integration of medication information.
- Use of electronic health records.
In addition to summarizing information on care coordination from the QDR, this chartbook tracks individual measures of care coordination, overall and for populations defined by age, race, ethnicity, income, education, insurance, and number of chronic conditions.
Page originally created July 2016