Abstract
BackgroundCare coordination has increasingly been recognized as an important aspect of high-quality health care delivery. Robust measures of coordination processes will be essential tools to evaluate, guide and support efforts to understand and improve coordination, yet little agreement exists among stakeholders about how to best measure care coordination. We aimed to review and characterize existing measures of care coordination processes and identify areas of high and low density to guide future measure development.MethodsWe conducted a systematic review of measures published in MEDLINE through April 2012 and identified from additional key sources and informants. We characterized included measures with respect to the aspects of coordination measured (domain), measurement perspective (patient/family, health care professional, system representative), applicable settings and patient populations (by age and condition), and data used (survey, chart review, administrative claims).ResultsAmong the 96 included measure instruments, most relied on survey methods (88%) and measured aspects of communication (93%), in particular the transfer of information (81%). Few measured changing coordination needs (11%). Nearly half (49%) of instruments mapped to the patient/family perspective; 29% to the system representative and 27% to the health care professionals perspective. Few instruments were applicable to settings other than primary care (58%), inpatient facilities (25%), and outpatient specialty care (22%).ConclusionsNew measures are needed that evaluate changing coordination needs, coordination as perceived by health care professionals, coordination in the home health setting, and for patients at the end of life.
Highlights
Care coordination has increasingly been recognized as an important aspect of high-quality health care delivery
We identified existing measures of care coordination processes published in the peer-reviewed literature or identified by a panel of stakeholders, and categorized those measures according to the aspects of coordination measured, patient populations to whom they have been applied, settings where they have been used, and the types of data used
Care coordination measurement framework Because care coordination remains ill-defined and is potentially quite broad, we developed a framework to aid in description and classification of the measure instruments, and to structure assessment of the measurement landscape—which areas have a high density of existing measures, and which are more sparsely populated
Summary
Care coordination has increasingly been recognized as an important aspect of high-quality health care delivery. Care coordination has increasingly been recognized as an important aspect of high-quality health care delivery, and a national priority area for improving patient care across the lifespan [1,2]. Robust measures of coordination processes will be essential tools to evaluate, guide and support efforts to understand and improve consequential deficits in care coordination. In addition to evaluating the effectiveness of improvement initiatives, such measures are important to identify deficiencies addressable by quality improvement efforts, may be used for comparative reporting or accountability and recognition purposes, and are essential for evaluating how care coordination is related to patient outcomes
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