This chapter contains:
- An overview of how existing measures for clinical-community relationships are organized within the measurement framework described in Chapter 3.
- A table of existing measures mapped to the measurement framework.
- An explanation of how to use the table (Table 4-1) to identify measures of clinical-community relationships.
4.1 Measure Mapping Table
To classify the clinical-community relationship measures according to the two dimensions of the measurement framework, a Measure Mapping Table was developed that displays the intersection of clinical-community relationship measurement domains (listed vertically) and the elements or relationships that would be the focus of each measure (listed horizontally). Measures were indexed, or "mapped," according to the measure domain into which they fall in order to indicate which aspect of clinical-community relationships the measure is assessing.
The measures contained in the CCRM Atlas were identified during an environmental scan that was conducted in 2011 to identify existing measures of linkages between clinical practices and community organizations. Appendix C provides further details regarding the environmental scan and how the information for each measure was extracted.
Each existing measure identified to be relevant to clinical-community relationships has a profile that provides details regarding the measure. Exhibit 4-1 provides a listing and explanation of the information collected for measures. The profiles for each measure are in Chapter 5. Relevant information for each section of the profile was obtained and extracted from publications identified through the environmental scan of clinical-community relationship measures mentioned above. It should be noted that when measures that focused on mental health settings were determined to be adaptable for primary care settings, these measures were included in the CCRM Atlas.
As noted previously, the field of clinical-community relationships is in its infancy as are the measures that assess these relationships. Many measures included in the CCRM Atlas are from selected sections of survey instruments. Users are cautioned that even though individual items from surveys are mapped to particular domains, most instruments should be used in their entirety. Typically, measure testing is conducted on the entire measure; performance of measurement based on individual items is usually unknown. Further research, such as psychometric and validity testing may need to be conducted on these measures in a clinical-community relationship setting. It may be possible to seek advice directly from a measure developer about any potential adaptations.
4.2 Master Measure Mapping Table
Each existing measure of clinical-community relationships was mapped to a domain in the measurement framework. The Master Measure Mapping Table (go to Table 4-1) presents the existing measures that align to clinical-community relationship domains and the element(s) or relationship(s) that the measure assesses. A shaded cell for a domain in a particular row indicates that the domain does not apply to the element or relationship in the corresponding column. A non-shaded cell for a domain in a particular row indicates that the domain does apply to the element or relationship in the corresponding column. A blank non-shaded cell indicates that no measures currently exist for the domain.
The numbers in parentheses indicate the total existing measures for a specific domain and element/relationship. For example, there are three identified measures for the clinician experience domain to assess the clinic/clinician-community resource relationship. The measure numbers following the parentheses correspond to the number assigned to each measure on Table 5-1, the List of Measures. Hence, the following three measures are under the clinician experience domain to assess the clinic/clinician-community resource relationship:
- #9—Physician satisfaction with service coordination (Alzheimer's Service Coordination Program [ASCP] Physician Survey).
- #11—Whether or not a clinician would refer any family caregiver to intervention in the future (ASCP Physician Survey).
- #21—The effectiveness of communication between practice and community resource (GP-CLI Interview).
4.3 How to Select a Measure—The Measure Selection Guide
This section is intended to help users identify existing clinical-community relationship measures that can help evaluate their clinical-community relationship interventions, demonstration projects, or other research initiatives.
Two key steps are involved in finding a measure to meet your evaluation needs:
- Identify the measures relevant to your intervention.
- Review the relevant measure profiles.
Identifying the measures relevant to your intervention involves the steps outlined below:
- Specify the element(s) or relationship(s) of interest (i.e., choose a column in Table 4-1).
- Specify the domains of a clinical-community relationship that are of interest (i.e., choose a row in Table 4-1).
- Go to the intersection of the column you selected in step (a) and the row you chose in step (b) to identify the relevant measures.
Once you have identified the relevant measures, go to the Measure Profiles in Chapter 5 to examine the relevant measures in more detail and determine whether they meet your evaluation needs.
4.3.1 An Example of How to Use the Guide
More detailed guidance for implementing the above steps is provided below.
- Identify the measures relevant to your intervention.
Example:3
Dr. X is developing a 6-month program to improve awareness of sexually transmitted infections (STIs) among his patients. Dr. X is going to refer patients to one of three available community centers that provide STI and sexual health counseling. Dr. X will use a brief questionnaire during his consultations with patients to prescreen those eligible for a referral as well as assess the patient's level of readiness for behavior change. Those patients who agree to participate in the program will be given a prescription for counseling, which serves as a referral form for free counseling at any of the three community centers. The community centers agreed to maintain a list of all clients who came for STI and sexual health counseling at the respective sites as well as who completed the counseling. At the end of the program, the community centers will supply Dr. X with the listing of clients who came at least once and a list of those who actually completed their services.
Dr. X is interested in understanding the following:
- Is there any correlation between the patient's level of readiness for behavior change and the patient's acting on the referral?.
- Will the prescription for free counseling result in more patients using the counseling services? Dr. X tried verbal referrals a year ago with a similar group of patients; most patients from that group did not use the counseling services.
- Specify the element(s) or relationship(s) of interest.
A single intervention may involve multiple elements or relationships as units of analysis in an evaluation of the intervention. Hence, it is important that you first identify which element(s) and/or relationship(s) you are interested in. Questions to consider include: Who is the intervention primarily targeted toward? Who will carry out the intervention?
The intervention in the above example is targeted toward patients. The community centers will be helping to carry out the intervention by supplying Dr. X with the listing of clients who (1) used the services (i.e., came at least once) and who (2) completed the services. Hence the element and relationship that are of interest here are:
- Element: patient.
- Relationship: patient—community resource.
- Specify the domains of a clinical-community relationship that are of interest.
A single intervention may employ multiple mechanisms whose effect you may want to measure. Therefore, you will want to map each one to a measurement domain.
Using the example listed above, Dr. X is interested in the effect of the patient's readiness for change and the prescription for a free referral on the rate of confirmed referrals and the rate of delivery of services. Hence, the measurement domains of interest are:
- Readiness for behavior change (patient element).4
- Referral process (patient-community relationship element).
- Delivery of service (patient-community relationship element).
Each domain is listed on the relevant rows of the Master Measure Mapping Table (Table 4-1).
- Identify relevant clinical-community relationship measures.
Using the element(s) and/or relationship(s) you identified in step "a" and the domain(s) you identified from step "b", locate the relevant clinical-community relationships measures on the Master Measure Mapping Table by finding where they intersect.
For example, if you are looking for a measure of patient's readiness for behavior change, scan down the Patient Element column until you reach the row with readiness for behavior change. The box that represents the intersection of this column and row lists the existing measure(s) in the CCRM Atlas that evaluate a patient's readiness for behavior change—measures 2 and 18.
Similarly, if you are interested in evaluating the prescription for counseling effect on the patient's rate of confirming the referral by contacting the community service, look at the measure(s) in the referral process domain of the patient-community resource relationship: Measure 16. Since you might also be interested in the effect of either the prescription or the patient's readiness for change on actual completion of counseling services, look at the measure(s) in the delivery of service domain of the patient-community resource relationship: there currently aren't any measures within this domain indicating the need for measure development and testing.
- Review relevant measure profiles.
Once you have identified the measures you need to evaluate your intervention, go to the Measure Profiles in Chapter 5 to obtain more information about each measure. This information should be used to guide the selection of specific measures for use in evaluating the intervention.
3. This example is a quality improvement activity and it is assumed that the clinician explicitly obtained the patients' approval to share/receive information with the community resources.
4. Several measurement domains can be used to categorize measures that apply to multiple elements/relationships.
