Care Coordination Measures Atlas Update

Measures 66-69

Measure #66. Interpersonal Processes of Care Survey

Care Coordination Measure Mapping Table

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

Interpersonal Processes of Care Survey

Purpose: To evaluate patient-reported, multidimensional physician/patient interpersonal processes of care, in a manner appropriate for patients from diverse racial or ethnic groups.

Format/Data Source: A 29-item, telephone-based survey asking patients to report whether their doctor had engaged in particular communication and patient-centered decisionmaking activities, as well as particular aspects of their doctor’s interpersonal style over the preceding 12 months. The measure assesses three main aspects of interpersonal processes of care: (1) communication, (2) decisionmaking, and (3) interpersonal style. Survey administration takes approximately 30 minutes. Responses are on a five-point scale, with choices corresponding to never, rarely, sometimes, usually, and always.¹

Date: Measure released in 2007.¹

Perspective: Patient/Family

Measure Item Mapping:

• Communicate:
  • • Between health care professional(s) and patient/family: 6, 7, 16
  • Interpersonal communication:
    • Between health care professional(s) and patient/family: 9, 10, 11, 12
• Assess needs and goals: 6, 7, 14
• Create a proactive plan of care: 15, 16
• Support self-management goals: 13
• Medication Management: 11, 12

Development and Testing: Six of the 7 scales met the conventional standard of reliability score >0.70; the lack of clarity (in communication) scale had a borderline reliability score of 0.65. Within-group reliabilities were also high for all four patient groups in which the scales were tested, with a range of 0.65-0.91. The items and instructions were rated at an 8^th grade reading level, with the 18-item short form rated at a 5^th grade level. Scales were derived through iterative factor analysis.¹

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

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

Country: United States

Past or Validated Applications*:

• Patient Age: Adults
• Patient Condition: Not Condition Specific
• Setting: Primary Care Facility

*Based on the source listed below.

Notes:

• All instrument items are located in table 5 of the source article.¹
• This instrument contains 29 items, of which 10 were mapped.
• A short-form version of this survey containing 18 items is also available.¹
• Spanish versions of both forms of the survey are also available.¹
• This survey is designed to be appropriate for diverse racial and ethnic groups, including African Americans, English- and Spanish-speaking Latinos, and non-Latino whites.¹

Sources:

1. Stewart AL, Napoles-Springer AM, Gregorich SE, et al. Interpersonal processes of care survey: patient-reported measures for diverse groups. Health Serv Res 2007;42(3 Pt 1):1235-56.

Measure #67. Brief 5 A’s Patient Survey

Care Coordination Measure Mapping Table

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

Brief 5 A’s Patient Survey

Purpose: To evaluate patients’ experiences in receiving support for managing their health.

Format/Data Source: A 10-item survey asking patients whether their health care team has performed particular self-management support activities. Available response choices are yes, no and don’t know.¹

Date: Measure released in 2006.¹

Perspective: Patient/Family

Measure Item Mapping:

• Communicate:
  • Interpersonal communication:
    • Between health care professional(s) and patient/family: 1
  • Information transfer:
    • Between health care professional(s) and patient/family: 2
• Assess needs and goals: 5, 6
• Create a proactive plan of care: 7, 8
• Monitor, follow up, and respond to change: 10
• Support self-management goals: 1, 2, 3, 4, 5, 6, 7, 8
• Link to community resources: 9

Development and Testing: None described in the sources identified.

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

Logic Model/Conceptual Framework: This survey is based on the “5As” (Assess, Advise, Agree, Assist, Arrange) model of behavior change counseling, which has been applied to self-management support for patients with chronic conditions.^{1, 2}

Country: United States

Past or Validated Applications*:

• Patient Age: Not Age Specific
• Patient Condition: Not Condition Specific
• Setting: Not Setting Specific

*Based on the source listed below.

Notes:

• All instrument items are located in Figure 3 of the source article.¹
• This instrument contains 10 items, of which 10 were mapped.

Sources:

1. Glasgow RE, Emont S, Miller DC. Assessing delivery of the five 'As' for patient-centered counseling. Health Promot Int 2006;21(3):245-55.
2. Glasgow RE, Goldstein MG, Ockene JK, et al. Translating what we have learned into practice. Principles and hypotheses for interventions addressing multiple behaviors in primary care. Am J Prev Med 2004;27(2 Suppl):88-101.

Measure #68. Patient Perceived Continuity of Care from Multiple Providers

Care Coordination Measure Mapping Table

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

Patient Perceived Continuity of Care from Multiple Providers

Purpose: To measure management continuity from the perspective of patients with health problems who regularly see more than one clinician.

Format/Data Source: A 53-item, paper-based survey asking patients to report their experiences with continuity of care. Questions focus on assessing the roles of the clinicians as care coordinators, with a total of 8 constructs across 9 subscales. Three subscales relate to the principal clinician and cover management and relational continuity (coordinator role, comprehensive knowledge of patient, confidence and partnership). Four subscales are related to multiple clinicians and address team relational continuity and problems with coordination and gaps in information transfer (confidence in team, role clarity and coordination [2 subscales], information gap between clinicians). Two subscales pertain to the patient’s partnership in care (evidence of a care plan, self-management information provided). Response choices are on a 5-point Likert-type scale for most questions, with a 3-point scale for some.¹

Date: Measure released in 2012.¹

Perspective: Patient/Family

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 11, 17, 19, 37, 38, 39, 41f, 41g, 41k
• Communicate:
  • • Between health care professional(s) and patient/family: 3, 4, 5
    • Within teams of health care professionals: 9, 17, 41h, 41k
    • Across health care teams or settings: 13, 17, 41h, 41k
  • Interpersonal communication:
    • Between health care professional(s) and patient/family: 16, 20, 21, 22, 23, 24, 25
    • Across health care teams or settings: 15
  • Information transfer:
    • Between health care professional(s) and patient/family: 32, 33, 34, 35
    • Across health care teams or settings: 27, 28, 29, 31, 41e
• Facilitate transitions:
  • Across settings: 14, 16, 17, 19, 23, 27, 28, 29, 31, 41k
  • As coordination needs change: 41i
• Assess needs and goals: 3, 4, 5, 12, 24, 37
• Create a proactive plan of care: 19, 20, 21, 22, 23, 24, 41i
• Monitor, follow up, and respond to change: 11, 41j
• Support self-management goals: 21, 25, 32, 33, 34, 35, 41l
• Teamwork focused on coordination: 9, 18, 19, 36

Development and Testing: Measure items were developed based on themes from 23 existing instruments measuring patient experience with care from various clinicians. The measure was validated with patients ages 25 to 75 years old. Item-scale correlations generally indicated high consistency within the subscales, with an internal reliability that was higher than the generally accepted score of 0.70; the role clarity and coordination within the clinic subscale had a borderline reliability score of 0.66. This somewhat lower value reflected the small number of respondents consulting various clinicians in their regular clinic in the last 6 months. Factor analysis showed that all items loaded within the expected patterns. Odds ratios of occurrence of indicators of problem continuity demonstrated that all but one of the subscale constructs were protective against discontinuity of care (OR 0.16 to 0.67). One of the subscales indicated an increased risk of discontinuity, inappropriate ED use, and medical errors (OR 2.67 to 18.05).¹

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

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

Country: United States

Past or Validated Applications*:

• Patient Age: Adults
• Patient Condition: Not Condition Specific
• Setting: Primary Care Facility, Other Outpatient Specialty Care Facility

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

Notes:

• All instrument items are located in an online supplementary appendix associated with the main source article.¹
• This instrument contains 53 items, of which 39 were mapped.
• A French version of the survey is also available.¹

Sources:

1. Haggerty JL, Roberge D, Freeman GK, et al. Validation of a generic measure of continuity of care: when patients encounter several clinicians. Ann Fam Med 2012;10(5):443-51.

Measure #69. Relational and Management Continuity Survey in Patients with Multiple Long-Term Conditions

Care Coordination Measure Mapping Table

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

Relational and Management Continuity Survey in Patients with Multiple Long-Term Conditions

Purpose: To quantify problems of relational and management continuity in patients with multiple long-term conditions.

Format/Data Source: A 25-item self-administered survey. Item responses use a 4-point Likert-type scale indicating frequency of experiencing varies kinds of management and relational continuity. The survey contains 4 sections: (1) utilization of services, (2) management continuity, (3) relational continuity, and (4) access, flexibility, and satisfaction. Scores calculated for each of two factors (management continuity, relational continuity) indicate the number of difficulties experienced by patients for that type of continuity.¹

Date: Measure released in 2011.¹

Perspective: Patient/Family

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 30, 31, 36
  • Interpersonal communication:
    • Between health care professional(s) and patient/family: 11
    • Within teams of health care professionals: 30
  • Information transfer:
    • Across health care teams or settings: 25, 26, 27, 28, 29
• Assess needs and goals: 11, 13
• Create a proactive plan of care: 31
• Monitor, follow up, and respond to change: 7
• Teamwork focused on coordination: 30, 37

Development and Testing: Psychometric testing in a sample of 1,125 patients age 60 and older from 15 general practices in the U.K. demonstrated good reliability and validity. Confirmatory factor analysis revealed that survey items cluster into two factors: management continuity (7 items, Cronbach’s alpha 0.884) and relational continuity (9 items, Cronbach’s alpha 0.830). Other items showed poor results and were omitted from analyses. Patients with a greater number of self-reported chronic conditions were more likely to experience three or more difficulties in management continuity (p<0.05) compared to those with fewer chronic conditions, controlling for age, sex, clinic, and health care utilization. In contrast, difficulties in relational continuity were not associated with chronic disease burden. Patients with greater numbers of general practice visits experienced fewer relational continuity difficulties.¹

Link to Outcomes or Health System Characteristics: Hospital outpatient consultations (specialty visits) and emergency department visits were strongly associated with greater difficulties in management continuity but not relational continuity among older adults in U.K. general practices, when controlling for age, sex, clinic, and number of chronic conditions. Patients with poorer self-rated health also reported experiencing greater difficulties in both management and relational continuity in adjusted analyses. Practice size and number of physicians in a practice were not associated with either management or relational continuity. Difficulties in management continuity were greater at clinics where patients experienced lower relational continuity (p<0.02).¹

Logic Model/Conceptual Framework: This measure emerges from conceptual work on differing aspects of continuity of care.^{1, 2}

Country: UK

Past or Validated Applications*:

• Patient Age: Adults, Older Adults
• Patient Condition: Combined Chronic Conditions, General Chronic Conditions, Multiple Chronic Conditions
• Setting: Primary Care Facilities

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

Notes:

• All instrument items are located in Table 2 of the source article.¹
• This instrument contains 25 items, of which 12 were mapped.

Sources:

1. Gulliford M, Cowie L, Morgan M. Relational and Management Continuity Survey in Patients with Multiple Long-Term Conditions. Journal of Health Services & Research Policy 2011;16(2):67-74.
2. Gulliford M, Naithani S, Morgan M. What is 'continuity of care'? Journal of Health Services & Research Policy 2006;11(4):248-50.

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