Care Coordination Measures Atlas Update

Measures 46-49

Measure #46. Relational Coordination Survey

Care Coordination Measure Mapping Table

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

Relational Coordination Survey

Purpose: To determine the impact of relational coordination on quality of care by measuring dimensions of communication and relationships among health care providers and testing their impact on performance.

Format/Data Source: 7-item survey consisting of 4 communication dimensions (frequent, timely, accurate, problem solving) and 3 relationship dimensions (shared goals, shared knowledge, mutual respect).

Date: Measure published in 2000.¹

Perspective: Health Care Professional(s)

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 5, 6
• Communicate:
  • Across health care teams or settings: 1-3
• Assess needs and goals: 7
• Teamwork focused on coordination: 4, 7

Development and Testing: The Cronbach's alphas for the individual dimensions of relational coordination ranged from 0.717 to 0.840, and the overall index of relational coordination had a Cronbach's alpha of 0.849.¹

Link to Outcomes or Health System Characteristics: Higher levels of relational coordination among care providers was significantly associated with improved quality of care (measured by a quality-of-care index developed from 25 questionnaire items from the Service Quality Questionnaire pertaining to the patient's acute-care experience). Postoperative freedom from pain associated with the overall index of relational coordination. Frequency of communication, shared goals, shared knowledge, and mutual respect were significantly associated with patient freedom from pain.¹

Logic Model/Conceptual Framework: This instrument is based on the concept of relational coordination which is defined as, “coordination that is carried out by front-line workers with an awareness of their relationship to the overall work process and to other participants in that process.”² Health care settings characterized by high levels of uncertainty, interdependence, and time constraints can utilize relational coordination to improve quality and efficiency of performance by improving the exchange of information relevant to the care of a given patient.

Country: United States

Past or Validated Applications*:

• Patient Age: Older Adults, Adults, Not Age Specific
• Patient Condition: Combined Chronic Conditions, General Chronic Conditions, Other – total joint arthroplasty, General Population/Not Condition Specific
• Setting: Inpatient Care Facility, Primary Care Facility, Long Term Care Facility

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

Notes:

• All instrument items are located online.³
• This instrument contains 7 items; all 7 were mapped.
• The Measure Item Mapping portion of the profile refers to the question items found in the Relational Coordination Survey for Patient Care. For those interested in either the Short Form Relational Coordination Survey for Nursing Homes or the Relational Coordination Survey for Patient Care, by Individual Patient, both can be found online.²

Sources:

1. Gittell JH, Fairfield KM, Bierbaum B, et al. Impact of relational coordination on quality of care, postoperative pain and functioning, and length of stay. Med Care 2000;38(8):807-19.
2. Gittell JH. Organizing work to support relational coordination. Int J Hum Resour Man 2000;11(3):517-39.
3. Relational Coordination Web site. Available at: http://www.jodyhoffergittell.info/content/rc.html. Accessed: 13 September 2010.
4. Gittell JH. Coordinating mechanisms in care provider groups: Relational coordination as a mediator and input uncertainty as a moderator of performance outcomes. Mgt Science 2002; 48(11): 1408-1426.
5. Weinberg, D, Lusenhop, W, Gittell, et al. Coordination between formal care providers and informal caregivers. Health Care Manage R 2007; 32(2): 140-150.
6. Gittell JH, Weinberg, DB, Bennett, et al. Is the doctor in? A relational approach to job design and the coordination of work. Hum Resource Manage 2006; 47(4): 729-755.
7. Gittell, JH, Weinberg, D, Pfefferle, S, Bishop, C. Impact of relational coordination on job satisfaction and quality of care: A study of nursing homes. Hum Resource Manage 2008; 18(2): 154-170.
8. Havens, DS, Vasey, J, Gittell, JH, Lin, W. Relational coordination among nurses and other providers: Impact on the quality of care. J Nurs Manage 2010; 18: 926-937.

Measure #47. Fragmentation of Care Index (FCI)

Care Coordination Measure Mapping Table

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items
*The use of a filled square for this measure indicates that it is a composite measure

Fragmentation of Care Index (FCI)

Purpose: To determine whether referrals to specialists for outpatient screening for coexisting conditions were offset by the potentially deleterious effects of care fragmentation.

Format/Data Source: The FCI is calculated using an equation that utilizes data on: (1) the total number of visits, (2) the total number of clinics visited, and (3) the total number of visits to a specific clinic being examined. The FCI can range from 0 (all visits were made to the same clinic) to 1 (all visits took place at a different clinic).

Date: Measure published in 2010.¹

Perspective: System Representative(s)

Measure Item Mapping:

• Health Care Home: composite measure

Development and Testing: Development of the FCI was based on the previously validated Continuity of Care Index described by Bice and Boxerman.²

Link to Outcomes or Health System Characteristics: Univariate analysis revealed a significant association between the FCI and the number of emergency department (ED) visits. The number of ED visits increased as the FCI increased (incidence rate ratio of 1.18; 95% CI 1.12-1.25).¹

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

Country: United States

Past or Validated Applications*:

• Patient Age: Adults
• Patient Condition: Combined Chronic Conditions, General Chronic Conditions, Multiple Chronic Conditions
• Setting: Primary Care Facility, Other Outpatient Specialty Care Facility

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

Notes:

• Formula located in the Methods section of the source article.¹

Sources:

1. Liu CW, Einstadter D, Cebul RD. Care fragmentation and emergency department use among complex patients with diabetes. Am J Manage Care 2010;16(6):413-20.
2. Bice TW, Boxerman SB. A quantitative measure of continuity of care. Med Care 1977;15(4):347-9.

Measure #48. After-Death Bereaved Family Member Interview

Care Coordination Measure Mapping Table

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

After-Death Bereaved Family Member Interview

Purpose: To assess the quality of end-of-life care from the perspective of the family of individuals who have died in a hospice, hospital, or nursing home setting.

Format/Data Source: Structured interview protocol consisting of 53 questions covering 7 different domains of care: (1) physical comfort and emotional support, (2) inform and promote shared decisionmaking, (3) encourage advanced care planning, (4) focus on individual, (5) attend to the emotional and spiritual needs of the family, (6) provide coordination of care, and (7) support the self-efficacy of the family.

Date: Measure released in 2000.¹

Perspective: Patient/Family

Measure Item Mapping:

• Establish accountability or negotiate responsibility: C2, C2a, D6, D7
• Communicate:
  • Between health care professional(s) and patient/family: D15a, F1
• Interpersonal communication:
  • Between health care professional(s) and patient/family: C1, C1a, C1b
• Information transfer:
  • Between health care professional(s) and patient/family: C1c, C1d, D26, D26a, D27, D27a, D28, D28a, E1
  • Across health care teams or settings: D18
• Medication management: D12, D12a, D15, D25, D28, D28a

Development and Testing: The instrument has been tested for all three settings (hospice, hospital, and nursing home) and it proved to be both reliable and valid.¹  Cronbach's alpha exceeded 0.70 for all domains with more than 4 items except for the Coordination of Care domain. For test-retest reliability, the Kappa and intra-class correlation statistics revealed evidence of stability of the reported responses.²

Link to Outcomes or Health System Characteristics: For each proposed score, bereaved family members of decedents who were under hospice care reported fewer problems, a higher rating of care, and improved self-efficacy.²

Logic Model/Conceptual Framework: The instrument is based on a conceptual model of patient focused, family-centered medical care. The model was developed based on results from a qualitative literature review of expert guidelines and from focus groups with bereaved family members across different settings of care.²

Country: United States

Past or Validated Applications*:

• Patient Age: Adults, Older Adults
• Patient Condition: Other – End-of-life
• Setting: Inpatient Facility, Long Term Care Facility, Home Health Care

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

Notes:

• All instrument items are available online.¹
• This instrument has 3 versions (hospice, hospital, and nursing home). All questions are nearly identical except for minor wording changes related to the setting. The hospice version has one additional question (D29b) not found in the other versions, and thus has a total of 54 questions.
• This instrument contains 53 items; 25 were mapped.

Sources:

1. Toolkit to measure end-of-life care (TIME): After-Death Bereaved Family Interview. Available at: http://www.chcr.brown.edu/pcoc/linkstoinstrumhtm.htm. Accessed: 7 October 2010.
2. Teno JM, Clarridge B, Case V, et al. Validation of toolkit After-Death Bereaved Family Member Interview. J Pain Symptom Manage 2001;22(3):752-8.
3. Toolkit of instruments to measure end-of-life care (TIME): After-Death Bereaved Family Member Interview. Providence, RI: Brown University; Copyright 1998-2004.

Measure #49. Schizophrenia Quality Indicators for Integrated Care

Care Coordination Measure Mapping Table

Legend:
■ = ≥ 3 corresponding measure items
□ = 1-2 corresponding measure items

Schizophrenia Quality Indicators for Integrated Care

Purpose: To develop a set of quality indicators for schizophrenia care to be used for continuous quality monitoring.

Format/Data Source: 12 structural and 22 quality indicators from a variety of source data (administrative data, additional provider data, patient survey).

Date: Measure published in 2010.¹

Perspective: System Representative(s); 1 item from Patient/Family perspective

Measure Item Mapping:

• Communicate:
  • Information transfer:
    • Between health care professional(s) and patient/family: Q18
    • Across health care teams or settings: S5
• Facilitate transitions:
• • Across settings: S5
• Assess needs and goals: Q12
• Create a proactive plan of care: Q15
• Monitor, follow up, and respond to change: Q4
• Support self-management goals: Q19
• Align resources with patient and population needs: S12
• Care management: Q13

Development and Testing: A systematic literature search was conducted to identify potentially relevant validated quality indicators. Two investigators independently selected all relevant quality indicators, and all were described based on the framework by Hermann and Palmer.² The final selection of indicators was conducted by a panel of stakeholders consisting of psychiatric experts, representatives of a service user, and a family advocacy organization. None of the selected indicators was validated in experimental studies, but evidence and validation base played only a subordinate role for indicator prioritization by stakeholders.¹

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

Logic Model/Conceptual Framework: Hermann and Palmer framework used to describe identified indicators.²

Country: Germany

Past or Validated Applications*:

• Patient Age: Not Age Specific
• Patient Condition: Combined Chronic Conditions, Mental Illness & Substance Use Disorders
• Setting: Not Setting Specific

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

Notes:

• All instrument items are located in Tables 2 and 3 of the source article.¹
• This instrument contains 34 items; 8 were mapped.

Sources:

1. Weinmann S, Roick C, Martin L, et al. Development of a set of schizophrenia quality indicators for integrated care. Epidemiol Psichiatr Soc 2010;19(1):52-62.
2. Hermann RC, Palmer H, Leff S, et al. Achieving consensus across diverse stakeholders on quality measures for mental health care. Med Care 2004;42:1246-53.

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