Care Coordination Measures Atlas Project

1. Care Coordination Measures Atlas Project Kathryn McDonald Stanford Health Policy AHRQ Quality Indicators Project

2. Project Team STANFORD/BATTELLE: • Ellen Schultz • Lauren Albin • Noelle Pineda • Julia Lonhart • Crystal Smith-Spangler • Jennifer Brustrom • Vandana Sundaram • Elizabeth Malcolm (Sutter) • Kathryn McDonald • AHRQ: • David Meyers • Jan Genevro • Mamatha Pancholi

3. Project Context: Measurement Motivation • Patient-Centered Medical Home • Evidence-based Practice Center (EPC) report on care coordination • HIT advances and opportunities • Transparency objectives: evidence & evaluations

4. Project Objective: Develop Measures Atlas • Target scope • Ambulatory care • Patients who have access to healthcare • The Atlas aims to support the field of care coordination measurement by: • Finding, selecting and cataloging existing measures of care coordination • Present best measures in accessible format • Expected Atlas Users: • Evaluators of interventions or demonstration projects that aim to improve care coordination • Quality improvement practitioners • Researchers studying care coordination

5. Methods • Literature search • Environmental scan • 2 workgroups and other informants • Framework development • Expert review • “Mapping” measures for two purposes: • Visualize landscape of measures available (and missing) • Help users target care coordination domains for intervention and measurement • Detailed measure profiles

6. Results Many available Depends on perspective Notion of “failures” White space Two dimensions Care coordination domains Perspectives Links to outcomes of interest (clinical, resource, IOM 6 dimensions of quality) Definitions Measurement Framework Area Lessons Learned

7. GOAL: COORDINATED CARE MECHANISMS Means of achieving goal Broad Approaches Commonly used groups of activities and/or tools hypothesized to support coordination. Coordination Activities Actions hypothesized to support coordination. Not necessarily executed in structured way. COORDINATION EFFECTS Experienced in different ways depending upon the perspective Patient/Family Perspective Healthcare Professional Perspective System Representative Perspective COORDINATION MEASURES Context: Settings; Patient Populations; Timeframe; Facilitators; Barriers

8. Measure Mapping Table

9. Results: Measures • Identified 150 measures • Mostly survey-based • Included better measures based on • Previous testing, use and/or underlying logic model • Applicability • Final measure count: 52

10. Measure Mapping and Profile • See handout • CTM-15 • 12: When I left the hospital, I had a readable and easily understood written list of the appointments or tests I needed to complete within the next several weeks. • CAHPS • CC1!: Doctor talked with patient about all of the prescription medicines he/she was taking • SP5: Patient phoned doctor’s office for help or advice after surgery or procedure

11. Next Steps • Text version available • Development of web-based version • Searchable • Explicit links to care coordination-related measures included in Electronic Health Record Incentive Program (Medicare and Medicaid) • Additional user testing and input • Section on applicability to practice’s ongoing QI efforts • Systematic research on evidence base on measurable mechanisms hypothesized to produce better care coordination (process-outcome links)