A Supplement to the Clinical-Community Relationships Measures Atlas
Prepared for:
Agency for Healthcare Research and Quality
5600 Fishers Lane
Rockville, MD 20857
Contract No: HHSA290-2010-000021
Prepared by:
Westat
Authors:
Maurice Johnson, Jr., M.P.H., Task Lead
Russ Mardon, Ph.D., Project Director
Contents
Acknowledgements
Executive Summary
1. Introduction
2. Potential Measure Development Methodology
2.1 General Measure Attributes
2.2 Potential Measures Context and Limitations
2.3 Potential Measures Template
3. Potential Measures
Clinic/Clinician Element
Patient Element
Community Resource Element
Clinic/Clinician-Patient Relationships
Clinic/Clinician-Community Resource Relationships
Patient-Community Resource Relationships
4. Recommended Core Measures and Next Steps
Appendixes
A-1. CCRM Measurement framework
A-2. Measurement framework domains and definitions
A-3. List of Measures from the CCRM Atlas
A-4. Measure 1: Patient recall of referral to local agencies
A-5. Measure 2: Parental interest in following up on the local agency referral
A-6. Measure 3: Parental confidence in being able to use a local agency referral
A-7. Measure 4: Clinician recall of referral to a local agency
A-8. Measure 5: Clinician perception of parent interest in referral
A-9. Measure 6: Clinician confidence in ability to instruct patient/family in proper use of local agency referral
A-10. Measure 7: Information about area (community) resources is offered by clinician
A-11. Measure 8: Plan of care includes at least one public and/or private community service/resource
A-12. Measure 9: Physician satisfaction with service coordination (Alzheimer’s Service Coordination Program Physician Survey)
A-13. Measure 10: Changes in clinicians’ knowledge of available services in the local community (ASCP Physician Survey)
A-14. Measure 11: Whether or not a clinician would refer any family caregiver to intervention in the future (ASCP Physician Survey)
A-15. Measure 12: Clinician receipt of treatment plan from the service coordinator (ASCP Physician Survey)
A-16. Measure 13: Clinician discussion of treatment plan with patients or family caregivers (ASCP Physician Survey)
A-17. Measure 14: Patients referred to a community health educator referral liaison (CHERL)
A-18. Measure 15: Patient engagement with CHERL
A-19. Measure 16: CHERL referrals to community resources
A-20. Measure 17: Referral rate for intensive counseling from a community program
A-21. Measure 18: Rate of patients that were ready to improve a targeted behavior
A-22. Measure 19: Connection to resource (Continuity of Care Practices Survey – Practice Level [CCPS-P])
A-23. Measure 20: Coordination of care [CCPS-P])
A-24. Measure 21: The effectiveness of communication between practice and community resource (GP-LI)
A-25. Measure 22: The quality of the service provided by community resource to a practice (GP-LI)
Clinical-Community Relationships Measures Expert Panel
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