Care Coordination Measures Atlas Update

Measures 74-77

Measure #74. Safety Net Medical Home Provider Experience Survey

Care Coordination Measure Mapping Table

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

*Indicates that the measure as a whole focused on the Health care home model.

Safety Net Medical Home Provider Experience Survey

Purpose: To measure health care professionals’ perceptions of patient-centered medical home (PCMH) characteristics and associated quality improvement in safety net clinics.

Format/Data Source: A 57-item survey asking a variety of health care professionals and staff practicing in safety net clinics to report their experiences with implementation of PCMH characteristics. The survey contains questions addressing 5 subscales, which include: (1) access to care and communication with patients, (2) communication with other providers, (3) tracking data, (4) care management, and (5) quality improvement. Response choices used a 5-point Likert-type scale and are then rescaled to a range of 1 – 100 points, with 0 indicating worst and 100 indicating best. Four of the five subscale scores are averaged to create a total PCMH score (excludes communication with other providers).¹

Date: Measure released in 2010.¹

Perspective: Health Care Professional

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 1a, 1b
• Communicate:
  • • Across health care teams or settings: 2a, 2b, 2c, 14d
  • Interpersonal communication:
    • Between health care professional(s) and patient/family:14b, 14c
    • Within teams of health care professionals: 12d
• Facilitate transitions:
  • Across settings: 2a, 2b, 2c
• Assess needs and goals: 6c
• Monitor, follow up, and respond to change: 3b, 14f
• Support self-management goals: 6d, 14a
• Link to community resources: 6f
• Align resources with patient and population needs: 6b, 6c
• Teamwork focused on coordination: 6e
• Health care home: 1a, 1b, 2a, 2b, 2c, 3b, 6b, 6c, 6d, 6e, 6f, 12d, 14a, 14b, 14c, 14d, 14f*

*The instrument as a whole focuses on the Health care home model. Only those items that map to at least one other care coordination domain are listed here.

Development and Testing: Questions were selected for each subscale based on content validity. Cronbach's alphas for the 5 subscales ranged from 0.48 (5-item access to care and communication with patients subscale) to 0.82 (7-item care management subscale), with an overall alpha of 0.87 for the total PCMH score.¹

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

Logic Model/Conceptual Framework: The 2008 National Committee for Quality Assurance PCMH standards.³

Country: United States

Past or Validated Applications*:

• Patient Age: Not applicable
• Patient Condition: Not applicable
• Setting: Primary Care Facility

*Based on the sources listed below.

Notes:

• All instrument items are located online.²
• This instrument contains 57 items, of which 17 were mapped.
• A version to assess staff experience is also available.

Sources:

1. Lewis SE, Nocon RS, Tang H, et al. Patient-Centered Medical Home Characteristics and Staff Morale in Safety Net Clinics. Archives of Internal Medicine 2012;172(1):23-31.
2. Commonwealth Fund. Safety Net Medical Home Provider Experience Survey. Available at: http://www.commonwealthfund.org/Innovations/Tools/2012/Jan/~/media/Files/Innovations/Jan/3a%20%20Provider%20Experience%20Survey.pdf. Accessed: August 5, 2013.
3. National Committee for Quality Assurance. PCMH Standards & Guidelines. Available at: http://www.ncqa.org/tabid/1016/Default.aspx. Accessed: August 1, 2011.

Measure #75. Rhode Island Physician Health Information Technology Survey

Care Coordination Measure Mapping Table

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

Rhode Island Physician Health Information Technology Survey

Purpose: To measure physicians’ use and integration of health information technology (HIT) and electronic medical records (EMRs) in their office or hospital clinical practice.

Format/Data Source: A 49 item, paper-based survey asking physicians to report their use of specific electronic medical record features for the primary purposes of information transfer and facilitation of care coordination within their clinical practice. The survey can assess level of EMR and e-prescribing implementation (basic or advanced) longitudinally. Questions are divided among 5 measures designed to ascertain physicians’ use of health information technology, including: (1) percentage of physicians with EMRs, (2) percentage of physicians with “qualified” EMRs, (3) basic EMR functionality use (scale of 0 – 100), (4) advanced EMR functionality use (scale of 0 –100), and (5) percentage of physicians who are e-prescribing.¹

Date: Measure released in 2009.¹

Perspective: Health Care Professional

Measure Item Mapping:

• Communicate:
  • Interpersonal Communication:
    • Across health care teams or settings: 16
  • Information Transfer:
    • Between health care professional(s) and patient/family: 20b
    • Across health care teams or settings: 14d, 17a, 17b, 17c, 19a, 19b, 19c, 19d, 21, 22, 23
• Facilitate transitions:
  • Across settings: 14d, 16
• Monitor, follow up, and respond to change: 18b, 20b
• Health IT-enabled coordination: 14d, 15a, 15b, 16, 17a, 17b, 17c, 18b, 19a, 19b, 19c, 19d, 20b, 21, 22, 23

Development and Testing: The pilot survey was reviewed by several expert panels comprised of academics, physicians, HIT professionals, Medicaid professionals, and commercial health plan professionals, and a survey design expert. Informal cognitive testing was performed with the expert panels, and the resulting consensus feedback was incorporated into the final version of the survey via an iterative process. Both measures differ by practice site, with office-based physicians less likely to have an EMR (58.4% vs. 83.4%, p < .0001) but more likely to have a “qualified” EMR (16.4% vs. 5.8%, p < .0001). Average use was higher for basic versus advanced functionalities: 63.6 on a 100-point scale for basic functionalities (Measure 3) and 44.1 points for advanced functionalities (Measure 4). Basic EMR functionality use was higher, on average, among office-based respondents (66.5 vs. 60.2 points, p = .0003) and lower in advanced functionality use (37.8 vs. 51.4 points, p < .0001). A majority of EMR users (n = 731, 57.5%) were using all six basic functionalities at least 60% of the time, and nearly half (n = 577, 45.1%) were using all 10 advanced functionalities at least 60% of the time.¹

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

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

Country: United States

Past or Validated Applications*:

• Patient Age: Not Applicable
• Patient Condition: Not Applicable
• Setting: Primary Care Facility, Inpatient, Emergency Department

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

Notes:

• All instrument items can be requested online at http://www.health.ri.gov/physicians/about/quality/index.php.²
• This instrument contains 49 items, of which 16 were mapped.
• There are two versions of the survey, an inpatient physician version and an outpatient physician version. Process measures are also calculated using the survey data, which include some components that map to coordination. Note that the measures are being developed for Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs), as well as physicians.¹
• Physicians who did not respond to this survey (required in Rhode Island) were assumed to not be utilizing EMRs, and therefore, were counted as “failing” all of the survey measures.³

Sources:

1. Baier RR, Gardner RL, Buechner JS, et al. Creating a survey to assess physicians' adoption of health information technology. Med Care Res Rev 2012;69(2):231-45.
2. Rhode Island Department of Health. Quality Information about Physicians, Advanced Practice Registered Nurses and Physician Assistants. Available at: http://www.health.ri.gov/physicians/about/quality/index.php. Accessed: August 6, 2013.
3. Baier R, Voss R, Morphis B, et al. Rhode Island physicians' health information technology (HIT) use, 2009-2011. Med Health R I 2011;94(7):215-7.

Measure #76. The Joint Commission Patient-Centered Medical Home Self-Assessment Survey

Care Coordination Measure Mapping Table

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

The Joint Commission Patient-Centered Medical Home Self-Assessment Survey

Purpose: To evaluate the coordination and comprehensiveness of patient-centered care in accordance with the principles of the patient-centered medical home (PCMH), in particular partnerships between the primary care clinician, interdisciplinary team, and patient.

Format/Data Source: A 66-item paper-based survey completed by health care organization administrators. The survey consists of 12 focus areas listed within 5 operational characteristics, which include: (1) patient-centeredness, (2) comprehensiveness, (3) coordination of care, (4) superb access to care, and (5) systems for quality/safety. Questions are answered in Yes/No responses, some of which required further written explanation.¹

Date: Measure released in 2011.²

Perspective: System Representative

Measure Item Mapping:

• Establish accountability or negotiate responsibility: I.A.1.e, I.B.1, I.C.3, II.B.1, II.B.4, III.A.1
• Communicate:
  • • Between health care professional(s) and patient/family: I.A.1.a, I.A.1.b, I.A.1.c, 1.A.1.d, I.A.1.e, I.A.1.f
    • Within teams of health care professionals: I.D.3
  • Interpersonal communication:
    • Between health care professional(s) and patient/family: I.D.2
  • Information transfer:
    • Within teams of health care professionals: V.A.1.f
• Facilitate transitions:
  • Across settings: II.A.1, III.A.2, III.A.3
  • As coordination needs change: II.A.2
• Assess needs and goals: I.D.1, II.A.2, II.B.5, II.B.6
• Create a proactive plan of care: I.C.2, I.E.3, III.A.4
• Monitor, follow up, and respond to change: V.A.1.b
• Support self-management goals: I.A.1.d, I.A.1.e, I.E.2, I.E.3, I.E.4, I.E.5, V.A.1.c
• Align resources with patient and population needs: I.D.4, I.E.2
• Teamwork focused on coordination: II.B.2, II.B.4
• Health care home: I.A.1.a-I.A.1.f, I.B.1, I.C.2-I.C.3, I.D.1-I.D.4, I.E.2-I.E.5, II.A.1-II.A.3, II.B.1, II.B.2, II.B.4-II.B.6, III.A.1-III.A.4, V.A.1.a-V.A.1.c, V.A.1.f*
• Care management: II.A.3
• Medication Management: I.A.1.e
• Health IT-enabled coordination: V.A.1.a, V.A.1.b, V.A.1.c, V.A.1.f

*The instrument as a whole focuses on the health care home model. Only those items that map to at least one other care coordination domain are listed here.

Development and Testing: An expert panel developed the standards for the Joint Commission’s PCMH option. After soliciting input from the field, draft standards were posted on the Joint Commission’s website for comment and piloted in primary care settings. The Joint Commission’s Board of Commissioners approved the finalized standards.²

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: Not Applicable
• Patient Condition: Not Applicable
• Setting: Primary Care Facility, Other Outpatient Specialty Care Facility

*Based on the sources listed below.

Notes:

• All instrument items are located online.²
• This instrument contains 66 items, of which 33 were mapped.
• A version of the survey specifically for ambulatory care practices that are owned/operated by an accredited hospital is also available from the measure steward.

Sources:

1. The Joint Commission Patient-Centered Medical Home (PCMH) Self-Assessment Tool web site.Available at: http://www.jointcommission.org/joint_commission_primary_care_medical_home_self-assessment_tool/. Accessed: May 10 2012.
2. Joint Commission on Accreditation of Healthcare Organizations. New Primary Care Medical Home Option for Accredited Ambulatory Care Organizations. Joint Commission Perspectives 2011;31(7):1-3

Measure #77. Communication with Referring Physicians Practice Improvement Module (CRP-PIM)

Care Coordination Measure Mapping Table

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

Communication with Referring Physicians Practice Improvement Module (CRP-PIM)

Purpose: To assess communication between referring physicians and physician consultants to whom they regularly refer patients.

Format/Data Source: A 35-item telephone or internet survey completed by referring physicians to assesses communication and care coordination performed by physician consultants to whom they have referred patients over the previous 12 months. Items are grouped into nine sections assessing: (1) the consulting physician, (2) contacting the consulting physician, (3) communications from the consulting physician, (4) coordination of care, (5) surgery or invasive procedures performed by the consulting physician, (6) overall rating of the consulting physician, (7) the consulting physician’s office staff, (8) about referring practices, and (9) about the respondent. Response scales include 6-point Likert-type responses and yes/no responses.

Date: Measure released in 2009.¹

Perspective: Health Care Professional(s)

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 3, 7, 8, 9, 15, 16, 17, 18, 22
• Communicate:
  • • Across health care teams or settings: 8, 9, 10, 11, 16, 18, 22, 23, 24
  • Interpersonal communication:
    • Between health care professional(s) and patient/family: 13
  • Information transfer:
    • Across health care teams or settings: 20, 29
• Facilitate transitions:
  • Across settings: 4, 6, 8, 9, 18, 23, 24
• Monitor, follow up, and respond to change: 23, 24
• Align resources with patient and population needs: 10

Development and Testing: To evaluate the survey, 803 consulting physicians requested feedback from over 12,000 physicians who regularly refer patients to them (average 15.21 referring physicians per consultant). Factor loading showed that item ratings were associated with two distinct dimensions of communication: contacting/communication with the consultant, and helpfulness of the consultant’s office staff. Correlation between the two category ratings was 0.41 (p < .001). Further analyses suggested good reliability.¹

Link to Outcomes or Health System Characteristics: Consulting physicians whose practice provided 24/7 nonphysician staff and telephone coverage for referring physicians, as well as those whose practice used a system outside the medical record to track referrals to and from other physicians, received significantly higher ratings on the helpfulness of office staff, as rated by referring physicians (p<0.01).¹

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

Country: United States

Past or Validated Applications*:

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

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

Notes:

• Instrument items may be requested from the American Board of Internal Medicine.
• This instrument contains 35 items, of which 18 were mapped.
• This instrument is one of 15 Web-based practice improvement modules for practicing physicians available from the American Board of Internal Medicine.

Sources:

1. Hess BJ, Lynn LA, Holmboe ES, et al. Toward Better Care Coordination Through Improved Communication With Referring Physicians. Academic Medicine 2009;84(10):S109-S12.

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