Chartbook on Care Coordination

Background

This Chartbook on Care Coordination is part of a family of documents and tools that support the National Healthcare Quality and Disparities Report (QDR). The QDR includes annual reports to Congress mandated in the Healthcare Research and Quality Act of 1999 (P.L. 106-129). These reports provide a comprehensive overview of the quality of health care received by the general U.S. population and disparities in care experienced by different racial, ethnic, and socioeconomic groups. The purpose of the reports is to assess the performance of our health system and to identify areas of strengths and weaknesses in the health care system along three main axes: access to health care, quality of health care, and priorities of the National Quality Strategy.

The reports are based on more than 250 measures of quality and disparities covering a broad array of health care services and settings. Data are generally available through 2013. The reports are produced with the help of an Interagency Work Group led by the Agency for Healthcare Research and Quality (AHRQ) and submitted on behalf of the Secretary of Health and Human Services (HHS).

Key Findings of the 2015 QDR

• Access to care has improved dramatically.
• Quality of care continues to improve, but wide variation exists across the National Quality Strategy (NQS) priorities:
  • Effective Treatment measures indicate improvements in overall performance and reductions in disparities.
  • Care Coordination measures have lagged behind other priorities in overall performance.
  • Patient Safety, Person-Centered Care, and Healthy Living measures have improved overall, but many disparities remain.
• Despite progress in some areas, disparities related to race and socioeconomic status persist among measures of access and all NQS priorities.
• Improvements in access were led by sustained reductions in the number of Americans without health insurance and increases in the number of Americans with a usual source of medical care.
• Care Affordability measures are limited for summarizing performance and disparities.
• Disparities in access tend to be more common than disparities in quality.

Chartbooks Organized Around Priorities of the National Quality Strategy

1. Making care safer by reducing harm caused in the delivery of care.
2. Ensuring that each person and family is engaged as partners in their care.
3. Promoting effective communication and coordination of care.
4. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
5. Working with communities to promote wide use of best practices to enable healthy living.
6. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

Care Coordination is one of the six priorities identified by the National Quality Strategy.

The National Quality Strategy has identified three long-term goals related to care coordination:

1. Improve the quality of care transitions and communications across care settings.
2. Improve the quality of life for patients with chronic illness and disability by following a current care plan that anticipates and addresses pain and symptom management, psychosocial needs, and functional status.
3. Establish shared accountability and integration of communities and health care systems to improve quality of care and reduce health disparities.

The goal of care coordination is to create a delivery system that is less fragmented and more organized, where handoffs are clear and patients and clinicians have the information they need to optimize the patient-clinician partnership (NQS, 2011). When all of a patient’s health care providers coordinate their efforts, it helps ensure that the patient receives appropriate care and support, when and how the patient needs and wants it. Effective care coordination models, such as patient-centered medical homes, have begun to show that they can deliver better quality care at lower costs in settings that range from small physician practices to large hospital centers.

Chartbook on Care Coordination

• This chartbook includes:
  • Summary of trends across measures of Care Coordination from the QDR.
  • Figures illustrating select measures of Care Coordination.
• Introduction and Methods contains information about methods used in the chartbook.

A Data Query tool provides access to all data tables.

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