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Care Coordination Measures Atlas Update

Chapter 6. Measure Maps and Profiles (continued, 6)

Measures 11-12

Measure #11a. Family-Centered Care Self-Assessment Tool — Family Version

Care Coordination Measure Mapping Table

  Measurement Perspective:
Patient/Family Health 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

Family-Centered Care Self-Assessment Tool — Family Version

Purpose: To evaluate practices' provision of family-centered health care from the family perspective

Format/Data Source: 98-item, written survey with questions across 3 domains: (1) family/provider partnerships, (2) care setting practices and policies, and (3) community systems of services and supports. These 3 domains are further divided into a total of 15 subtopics: (1) the decisionmaking team, (2) supporting the family as the constant in the child's life, (3) family-to-family and peer support, (4) supporting transition to adulthood, (5) sharing successes, (6) giving a diagnosis, (7) ongoing care and support, (8) addressing child/youth development, (9) access to records, (10) appointment schedules, (11) feedback on care setting practices, (12) care setting policies to support family-centered care, (13) addressing culture and language in care, (14) information and referral and community based services, and (15) community systems integration and care coordination. The subtopics are referred to for measure-item mapping.

Date: Measure released in 2008.1

Perspective: Patient/Family

Measure Item Mapping:

  • Establish accountability or negotiate responsibility: 1.1A, 1.1B, 1.1D, 4.2C, 7.1F
  • Communicate:
    • Between health care professional(s) and patient/family: 9.1A
  • Interpersonal communication:
    • Between health care professional(s) and patient/family: 1.2B, 1.2C, 1.5, 1.6, 2.1A-D, 3.1F, 7.1B-D, 7.1H, 8.1F
  • Information transfer:
    • Between health care professional(s) and patient/family: 1.4, 2.2A, 4.2E, 6.1A-C, 7.1E, 7.1G, 9.1D, 9.1E, 9.2, 12.1
    • Across health care teams or settings: 13.1D
    • Participants not specified: 4.2F
  • Facilitate transitions:
    • As coordination needs change: 1.2D, 3.1D, 4.2A-H, 8.1B, 8.1F, 14.2
  • Assess needs and goals: 1.2B-D, 1.3A-D, 2.1D, 7.5, 8.1B, 13.1A, 13.1B
  • Create a proactive plan of care: 4.2C, 4.2E, 13.1B
  • Monitor, follow up, and respond to change: 1.2D, 6.1A, 7.1F, 8.1A, 8.1F, 14.1C-F, 14.2
  • Support self-management goals: 1.1D, 1.2A, 2.2B, 3.1E, 3.1F, 4.2A, 4.2B, 6.1C, 6.1D, 7.1A, 7.1I, 8.1C-D, 13.1E
  • Link to community resources: 2.2B, 3.1B-D, 4.1C, 14.1A, 14.1B, 14.2, 15.1A
  • Align resources with patient and population needs: 1.1C, 3.1C, 3.1F, 4.2D, 4.2H, 7.1I, 7.3, 7.4, 9.1B, 9.1C, 10.1A-D, 12.2, 13.1C
  • Teamwork focused on coordination: 1.2A
  • Care management: 15.1B

Development and Testing: The instrument was developed based on 10 components of family-centered care within a framework for partnership between families and professionals. No detailed testing information was described in the sources identified.1

Link to Outcomes or Health System Characteristics: None described in the sources identified.

Logic Model/Conceptual Framework: National Center for Family-Centered Care Framework.2

Country: United States

Past or Validated Applications*:

  • Patient Age: Children
  • Patient Condition: Combined Chronic Conditions, Children with Special Health Care Needs
  • Setting: Not Setting Specific

*Based on the sources listed below and input from the measure developer.

Notes:

  • All instrument items are available online.1
  • This instrument contains 98 items; 90 were mapped.

Sources:

1. Family Voices, funded by the Maternal and Child Health Bureau (MCBH). Family Centered Care Self-Assessment Tool — Family Version. October 2008. Available at: http://www.familyvoices.org/resources. Accessed: 5 January 2011.
2. National Center for Family-Centered Care. Family-Centered Care for Children with Special Health Care Needs. Bethesda, MD: Association for the Care of Children's Health; 1989

Measure #11b. Family-Centered Care Self-Assessment Tool — Provider

Care Coordination Measure Mapping Table

  Measurement Perspective:
Patient/Family Health 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

Family Centered Care Self-Assessment Tool — Provider Version

Purpose: Family-Centered Care aims to improve the health and well-being of children through a respectful partnership between families and health care professionals. The Provider version aims to evaluate health care staff to determine the quality of care provided to the families.

Format/Data Source: 105-item, written survey administered to providers (health care professionals and staff). The Family-Centered Care Self-Assessment Tool — Provider Version covers 3 domains: (1) family/provider partnerships, (2) care setting practices and policies, and (3) community systems of services and supports. These 3 domains are further divided into 15 subtopics: (1) Decision-Making Team, (2) Supporting the Family as the Constant in the Child's Life, (3) Family-to-Family and Peer Support, (4) Supporting Transition to Adulthood, (5) Sharing Successes of the Family/Provider Partnership, (6) Giving a Diagnosis, (7) Ongoing Care and Support, (8) Addressing Child/Youth Development, (9) Access to Records, (10) Appointment Schedules, (11) Feedback on Care Setting Practices, (12) Care Setting Policies to Support Family-Centered Care, (13) Addressing Culture and Language in Care, (14) Information and Referral and Community-Based Services, and (15) Community Systems Integration and Care Coordination. The subtopics are referred to for measure-item mapping.

Date: Measure released in 2008.1

Perspective: Health Care Professional(s)

Measure Item Mapping:

  • Establish accountability or negotiate responsibility: 1.1A, 1.1B, 1.1D, 4.2C, 7.1F
  • Communicate:
    • Between health care professional(s) and patient/family: 1.2D, 8.1F, 9.1A, 9.1C
    • Within teams of health care professionals: 9.1E
  • Interpersonal communication:
    • Between health care professional(s) and patient/family: 1.2B, 1.2C, 1.4, 1.5, 4.1A, 7.1B, 7.1D, 7.1F, 7.1H
  • Information transfer:
    • Between health care professional(s) and patient/family: 2.2A, 2.2B, 6.1A, 6.1B, 7.1E, 7.1G, 9.1D, 12.1A, 12.1C
    • Within teams of health professionals: 4.2E
    • Participants not specified: 4.2F
  • Facilitate transitions:
    • As coordination needs change: 4.1A-C, 4.2A-H, 8.1B, 8.1F, 14.2
  • Assess needs and goals: 1.1B, 1.2B-E, 1.3A-E, 2.1A, 2.1D, 7.1D, 7.4, 8.1B, 13.1A, 14.2
  • Create a proactive plan of care: 4.1A, 4.2C, 4.2E, 13.1B
  • Monitor, follow up, and respond to change: 1.7, 7.1F, 8.1A, 8.1F, 14.1C-F, 14.2
  • Support self-management goals: 1.1C, 1.1D, 1.2A, 2.1A, 2.2A, 2.2B, 3.1E, 3.1F, 4.1B, 4.1C, 4.2A, 4.2B, 6.1C, 6.1D, 7.1F, 7.1H, 7.1I, 8.1C-F, 13.1E
  • Link to community resources: 1.1C, 2.2B, 3.1B-E, 4.1B, 4.1C, 14.1A, 14.1B, 14.2
  • Align resources with patient and population needs: 1.1C, 1.3A-E, 3.1C, 3.1F, 4.2D, 4.2H, 7.1I, 7.2, 7.3, 9.1B, 9.1C, 10.1A-D, 11.1-11.4, 12.1C, 12.1G, 12.1H, 13.1A-E
  • Teamwork focused on coordination: 1.2A
  • Care management: 15.1B

Development and Testing: The instrument was developed and based on 10 principles of family-centered care for children with special health needs within a framework for partnership between families and professionals. No detailed testing information was described in the sources identified.1

Link to Outcomes or Health System Characteristics: National Center for Family-Centered Care Framework.2

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

Country: United States

Past or Validated Applications*:

  • Patient Age: Children
  • Patient Condition: Combined Chronic Conditions, Children with Special Health Care Needs
  • Setting: Not Setting Specific

*Based on the sources listed below and input from the measure developer.

Notes:

  • All instrument items are available online.1
  • This instrument contains 105 items; 88 were mapped.

Sources:

1. Family Voices, funded by the Maternal and Child Health Bureau (MCBH). Family Centered Care Self-Assessment Tool — Family Version. October 2008. Available at: http://www.familyvoices.org/resources. Accessed: 17 September 2010.
2. National Center for Family-Centered Care. Family-Centered Care for Children with Special Health Care Needs. Bethesda, MD: Association for the Care of Children's Health; 1989

Measure #12a. ICU Nurse-Physician Questionnaire — Long Version

Care Coordination Measure Mapping Table

  Measurement Perspective:
Patient/Family Health 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

ICU Nurse-Physician Questionnaire — Long Version

Purpose: To measure clinician perceptions of collaborative interactions, with a specific focus on leadership, organizational culture, communication, problem-solving, team cohesiveness, and coordination.

Format/Data Source: 218-item survey consisting of 11 sections. Requires approximately 45 minutes to complete.

Date: Measure published in 1991.1

Perspective: Health Care Professional(s)

Measure Item Mapping:
(Sections II and III are property of Human Synergistics and were not mapped for this profile)

  • Communicate:
    • Between health care professional(s) and patient/family: I.39d-g
    • Within teams of health care professionals: I.5, I.17, I.35, I.312a-c, VIIA.e
    • Across health care teams or settings: VIIB.f, I.16
  • Interpersonal communication:
    • Between health care professional(s) and patient/family: 1.2B, 1.2C, 1.4, 1.5, 4.1A, 7.1B, 7.1D, 7.1F, 7.1H
  • Information transfer:
    • Within teams of health professionals: I.3, I.6, I.10, I.12, I.15, I.18, I.22, I.24, I.25, I.28, I.31, I.36, I.38, VIIA.i, VIIB.h
    • Across health care teams or settings: 1.8, I.20
  • Assess needs and goals: V.1, V.3, V.11a, V.11c
  • Create a proactive plan of care: I.36, I.38, VIIA.a, VIIA.b, VIIA.h, VIIB.a, VIIB.d, VIIB.e
  • Monitor, follow up, and respond to change: I.28
  • Teamwork focused on coordination: I.26, I.27, I.30, I.32, I.33, I.34, IV.1-48, V.9, VIA.1-16, VIB.1-16, VIIA.d, VIIA.f, VIIA.g, VIIB.b, VIIB.c, VIIB.g
  • Health IT-enabled coordination: VIIA.c, VIIB.i

Development and Testing: The instrument demonstrated high reliability and validity for almost all scales. Testing was conducted using a nationally representative sample from 42 medical/surgical intensive care units (ICUs), and findings were further supported by on-site observational evaluation visits. Individual member responses can be aggregated to a unit level for broader evaluation. Factor analysis and analysis of variance were conducted as part of the testing process.1

Link to Outcomes or Health System Characteristics: A team-satisfaction-oriented culture, strong leadership, open and timely communication, effective coordination, and open collaborative problem-solving, as assessed by the ICU Nurse-Physician Questionnaire, corresponded with better performing health care sites. Performance in these sites was assessed by on-site evaluations, which consisted of interviews, observation of practice, and comparison with a set of “best” and “worst” practices.1

Logic Model/Conceptual Framework: Author-developed framework of managerial (leadership, culture) and organizational (coordination, communication, conflict management) factors affecting ICU performance.1

Country: United States

Past or Validated Applications*:

  • Patient Age: Children
  • Patient Condition: Combined Chronic Conditions, Children with Special Health Care Needs
  • Setting: Not Setting Specific

*Based on the sources listed below and input from the measure developer.

Notes:

  • This instrument is available in nurse and physician versions. All questions are nearly identical in the two versions except for minor wording changes to reflect the appropriate audience. Both versions can be found online.2
  • This instrument is also available in a short version, which can be found online.2
  • This instrument contains 218 items; 157 were mapped.
  • The measure developers believe that this instrument can be successfully used in other settings, beyond ICU units. We included it in the Atlas because of its strong relevance to the framework domains, robust reliability and validity, and potential for adaptation to a variety of other health care settings.

Sources:

1. Shortell S, Rousseau DM, Gillies RR, et al. Organizational assessment in Intensive Care Units (ICUs): Construct development, reliability, and validity of the ICU Nurse-Physician Questionnaire. Med Care 1991;29(8): 709-27.
2. UC Berkeley School of Public Health: Stephen M. Shortell Research Projects Web site. Available at: http://shortellresearch.berkeley.edu/ICU%20Questionnaires.htm. Accessed: 22 September 2010.

Measure #12b. ICU Nurse-Physician Questionnaire — Short Version

Care Coordination Measure Mapping Table

  Measurement Perspective:
Patient/Family Health 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

ICU Nurse-Physician Questionnaire — Short Version

Purpose: To measure clinician perceptions of collaborative interactions, with a specific focus on leadership, organizational culture, communication, problem-solving, team cohesiveness, and coordination.

Format/Data Source: 85-item survey consisting of 6 sections. Requires approximately 20 minutes to complete.

Date: Measure published in 1991.1

Perspective: Health Care Professional(s)

Measure Item Mapping:

  • Establish accountability or negotiate responsibility:
  • Communicate:
    • Within teams of health care professionals: I.3, I.12, I.22
  • Interpersonal communication:
    • Within teams of health care professionals: I.1, I.6, I.8, I.10, I.15, I.17
  • Information transfer:
    • Within teams of health professionals: I.2, I.4, I.7, I.9, I.11, I.13, I.16, I.18-21
  • Assess needs and goals: III.1, III.3, III.11a, III.11c
  • Monitor, follow up, and respond to change: I.20
  • Teamwork focused on coordination: II.1-20, III.9, VIA.1-7, VIB.1-7

Development and Testing: The instrument demonstrated high reliability and validity for almost all scales. Testing was conducted using a nationally representative sample from 42 medical/surgical intensive care units (ICUs), and findings were further supported by on-site observational evaluation visits. Individual member responses can be aggregated to a unit level for broader evaluation. Factor analysis and analysis of variance were conducted as part of the testing process.1

Link to Outcomes or Health System Characteristics: A team-satisfaction-oriented culture, strong leadership, open and timely communication, effective coordination, and open collaborative problem-solving, as assessed by the ICU Nurse-Physician Questionnaire, corresponded with better performing health care sites. Performance in these sites was assessed by on-site evaluations, which consisted of interviews, observation of practice, and comparison with a set of “best” and “worst” practices.1

Logic Model/Conceptual Framework: Author-developed framework of managerial (leadership, culture) and organizational (coordination, communication, conflict management) factors affecting ICU performance.1

Country: United States

Past or Validated Applications*:

  • Patient Age: Not Applicable
  • Patient Condition: Not Applicable
  • Setting: Inpatient Facility

*Based on the sources listed below and input from the measure developer.*Based on the sources listed below and input from the measure developer.

Notes:

  • This instrument is available in nurse and physician versions. All questions are nearly identical in both versions except for minor wording changes to reflect the appropriate audience. Both versions can be found online.2
  • This instrument is also available in a long version, which can be found online.2
  • This instrument contains 85 items; 69 were mapped.
  • The measure developers believe that this instrument can be successfully used in other settings, beyond ICU units. We included it in the Atlas because of its strong relevance to the framework domains, robust reliability and validity, and potential for adaptation to a variety of other health care settings.

Sources:

1. Shortell S, Rousseau DM, Gillies RR, et al. Organizational assessment in Intensive Care Units (ICUs): Construct development, reliability, and validity of the ICU Nurse-Physician Questionnaire. Med Care 1991;29(8): 709-27.
2. UC Berkeley School of Public Health: Stephen M. Shortell Research Projects Web site. Available at: http://shortellresearch.berkeley.edu/ICU%20Questionnaires.htm. Accessed: 22 September 2010.

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Publication:
14-0037-EF

Previous Publication: 11-0023-EF

Page last reviewed June 2014
Page originally created June 2014

Internet Citation: Chapter 6. Measure Maps and Profiles (continued, 6). Content last reviewed June 2014. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/ncepcr/care/coordination/atlas/chapter6e.html

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