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Measures 42-45

Measure #42. Patient Perception of Continuity Instrument (PC)

Care Coordination Measure Mapping Table

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

Patient Perception of Continuity Instrument (PC)

Purpose: To measure longitudinal care using patient perceptions.

Format/Data Source: Mailed questionnaire consisting of 23 statements describing various aspects of an ongoing patient-physician longitudinal relationship. Questions cover two main factors: (1) structure of health care delivery (11 items) and (2) interpersonal relationship between physician and patients (12 items).

Date: Measure published in 1988.¹

Perspective: Patient/Family

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 2H, 2K
• Communicate:
  • Interpersonal communication:
    • Between health care professional(s) and patient/family: 2B, 2C, 2E, 2G
  • Information transfer:
    • Across health care teams or settings: 1B, 1G
• Facilitate transitions:
  • Across settings: 2J, 2M
• Assess needs and goals: 1H
• Medication management: 1D

Development and Testing: Face validity of the 23 statements included in the questionnaire was established by a comprehensive review conducted by a group of board-certified family physicians. The Cronbach's alpha was calculated at 0.86, indicating a high degree of internal consistency. A principal component factor analysis was conducted and revealed two main factors (structure of health care delivery and interpersonal relationship between physician and patients).^{1, 2}

Link to Outcomes or Health System Characteristics: There was no correlation between the PC measure and the calculated Usual Provider Continuity (UPC) and Continuity of Care (COC) values, two commonly used quantitative definitions of provider continuity. Patient perception of continuity, as measured by the PC instrument, was strongly and significantly associated with patient satisfaction, but was not associated with costs.¹

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

Country: United States

Past or Validated Applications*:

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

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

Notes:

• All instrument items are located online.²
• This instrument contains 23 items; 12 were mapped.

Sources:

1. Chao J. Continuity of care: Incorporating patient perceptions. Fam Med 1988;20:333-337.
2. Toolkit of Instruments to Measure End-of-Life Care (TIME) Web site. Available at: . Accessed: 13 September 2010.

Measure #43. Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration

Care Coordination Measure Mapping Table

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

Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration

Purpose: To evaluate the effectiveness of programs developed to foster physician-nurse collaboration and to study group differences on attitudes toward inter-personal collaboration.

Format/Data Source: 15-item survey that addresses 5 areas of physician-nurse interaction: (1) authority, (2) autonomy, (3) responsibility for patient monitoring, (4) collaborative decisionmaking, and (5) role expectations.

Date: Measure published in 1999.¹

Perspective: Health Care Professional(s)

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 4, 13-15
• Communicate:
  • Within teams of health care professionals: 6
• Interpersonal communication:
  • Between health care professional(s) and patient/family: 11
• Facilitate transitions:
• • Across settings: 6
• Assess needs and goals: 8
• Teamwork focused on coordination: 1

Development and Testing: Survey items were first developed based on a review of the literature. Construct validity of survey established by the consistency of the extracted factor structure of the survey. The alpha reliability estimates of the scale for medical and nursing students were 0.84 and 0.85.¹  Reliability coefficients were also high when testing was conducted in different countries (0.70 for nurses in Israel and Italy and 0.86 for physicians Mexico).²

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, Israel, Italy, Mexico

Past or Validated Applications*:

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

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

Notes:

• All instrument items are located in Table 1 of the source article.¹
• This instrument contains 15 items; 9 were mapped.
• This instrument is a modified version of the original Jefferson Survey of Attitudes Toward Physician-Nurse Collaboration.³

Sources:

1. Hojat M, Fields SK, Veloski J, et al. Psychometric properties of an attitude scale measuring physician-nurse collaboration. Eval Health Prof 1999;22:208-20.
2. Hojat M, Gonnella JS, Nasca TJ, et al. Comparisons of American, Israeli, Italian, and Mexican physicians and nurses on the total and factor scores of the Jefferson Scale of Attitudes toward Physician-Nurse Collaborative Relationships. Philadelphia: Thomas Jefferson University, Center for Research in Medical Education and Health Care; 2002. CRMEHC Faculty Papers.
3. Hojat M, Herman MW. Developing an instrument to measure attitudes toward nurses: Preliminary psychometric findings. Psychol Rep 1985;56:571-79.
4. Ward J, Schaal M, Sullivan J, et al. The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration: A study with undergraduate nursing students. J Interprof Care 2008;22(4):375-86.
5. Hojat M, Nasca TJ, Cohen MJM, et al. Attitudes toward physician-nurse collaboration a cross-cultural study of male and female physicians and nurses in the United States and Mexico. Nurs Res 2001; 50:123-128.
6. Hojat M, Fields SK, Rattner SL, et al. Attitudes toward physician-nurse alliance: Comparisons of medical and nursing students. Acad Med 1997; 1072:s1-s3.

Measure #44. Clinical Microsystem Assessment Tool (CMAT)

Care Coordination Measure Mapping Table

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

Clinical Microsystem Assessment Tool (CMAT)

Purpose: To allow an organization to compare its characteristics to those considered key to successful integration.

Format/Data Source: 10-item questionnaire covering the 10 success characteristics related to high performance: (1) leadership, (2) organizational support, (3) staff focus, (4) education and training, (5) interdependence, (6) patient focus, (7) community and market focus, (8) performance results, (9) process improvement, and (10) information and information technology.

Date: Measure developed in 2001.¹

Perspective: System Representative(s)

Measure Item Mapping:

• Communicate:
  • Information transfer:
    • Between health care professional(s) and patient/family: 10A
    • Within teams of health care professionals: 2, 10B
• Assess needs and goals: 6
• Monitor, follow up, and respond to change: 9
• Link to community resources: 7
• Teamwork focused on coordination: 5
• Health IT-enabled coordination: 10C

Development and Testing: Developed through a systematic analysis of 20 high-performing clinical microsystems in North America. The 2006 version has been field tested and utilized in the Neonatal Intensive Care Unit (NICU) setting. (N. Huber, personal communication, September 11, 2010).

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

Logic Model/Conceptual Framework: The following definition of microsystems in health care was utilized: “A clinical microsystem is a small group of people who work together on a regular basis to provide care to discrete subpopulations of patients. It has clinical and business aims, linked processes, and a shared information environment, and it produces performance outcomes. Microsystems evolve over time and are often embedded in larger organizations. They are complex adaptive systems, and as such they must do the primary work associated with core aims, meet the needs of internal staff, and maintain themselves over time as clinical units.”¹ The concept of the clinical microsystem is also being used by the Institute of Medicine's Crossing the Quality Chasm Report, The Institute for Healthcare Improvement's (IHI) Idealized Design of Clinical Office Practice program, and the IHI's Pursuing Perfection program.

Country: United States

Past or Validated Applications*:

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

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

Notes:

• All instrument items located online.^{1, 2}
• For those interested, the 2006 version of the CMAT includes additional leadership diagnostic survey questions and open ended questions for each of the 10 success characteristics.
• This instrument contains 12 items; 8 were mapped.

Sources:

1. Institute for Healthcare Improvement (IHI) Web site. Available at: . Accessed: 13 September 2010.
2. California Department of Healthcare Services Web site. Available at: . Accessed 13 September 2010.
3. Nelson EC, Batalden PB, Huber TP, et al. Microsystems in health care: Part 1. Learning from high-performing front-line clinical units. Jt Comm J Qual Improv 2002;28(9):472-93.
4. Armitage GD, Suter ES, Oelke ND, et al. Health systems integration: State of the evidence. Int J Integr Care 2009;19:1-11.

Measure #45. Components of Primary Care Index (CPCI)

Care Coordination Measure Mapping Table

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

Components of Primary Care Index (CPCI)

Purpose: To measure the major components of primary care from the perspective of the patient.

Format/Data Source: 19-item survey to be completed by the patient immediately following a visit with a physician. The survey covers 7 components of primary care: (1) comprehensiveness of care, (2) accumulated knowledge, (3) interpersonal communication, (4) coordination of care, (5) first-contact care, (6) continuity of care, and (7) longitudinality.

Date: Measure published in 1997.¹

Perspective: Patient/Family

Measure Item Mapping:

• Establish accountability or negotiate responsibility: 1, 14, 19
• Communicate:
  • Across health care teams or settings: 11
• Interpersonal communication:
  • Between health care professional(s) and patient/family: 6, 5, 8
• Information transfer:
  • Between health care professional(s) and patient/family: 7
  • Across health care teams or settings: 2, 10, 12
• Assess needs and goals: 4
• Monitor, follow up, and respond to change: 12, 13
• Health care home: 18

Development and Testing: A panel of experts consisting of practicing physicians, a health services researcher-biostatistician, a psychometrician-biostatistician, a sociologist, and a nurse administrator evaluated the content validity of the instrument. Revisions to the survey items were based on the panel's discussion and comments. The instrument was pilot tested with a sample of 43 patients from 3 different sites. Factor analysis was conducted and demonstrated good internal consistency reliabilities of 4 factors. The Cronbach's alpha for each factor was: patient preferences for their regular physician (0.74), interpersonal communication (0.68), accumulated knowledge of patient (0.75), and coordination of care (0.79). The validity of the instrument was established by demonstrating that CPCI scale scores are associated with 3 satisfaction measures consistent with theoretically derived hypotheses about the primary care concepts measured.¹

Link to Outcomes or Health System Characteristics: Adjusted linear regressions demonstrated that higher CPCI care coordination scale scores were highly associated with increased continuity of care as measured by the Continuity of Care Index (COC).²  Higher CPCI scale scores for primary care communication and coordination of care were associated with lower patient hassle scores as measured by a 16-item health care systems hassles scale.³  CPCI scale scores for interpersonal communication and coordination of care were shown to be significantly associated with the delivery of preventive screening services.⁴ In a population of women veteran patients, CPCI scores were higher for coordination if their provider offered gynecologic services or enrolled patients in a women's clinic.⁵

Logic Model/Conceptual Framework: Survey questions were modeled based on the 1994 Institute of Medicine (IOM) definition of primary care as well as the core elements of the 1978 IOM components of access, continuity, coordination, interpersonal communication, and comprehensive care.

Country: United States

Past or Validated Applications*:

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

*Based on the sources listed below.

Notes:

• All instrument items are located in Table 2 of the source article.¹
• This instrument contains 19 items; 14 were mapped.

Sources:

1. Flocke SA. Measuring attributes of primary care: Development of a new instrument. J Fam Pract 1997;45(1):64-75.
2. Christakis DA, Wright JA, Zimmerman FJ, et al. Continuity of care is associated with well-coordinated care. Ambul Pediatr 2003;3(2):82-86.
3. Parchman ML, Noel PH, Lee S. Primary care attributes, health care system hassles, and chronic illness. Med Care 2005;43(11):1123-8.
4. Flocke SA, Stange KC, Zyzanski SJ. The association of attributes of primary care with the delivery of clinical preventive services. Med Care 1998;36(8):AS21-30.
5. Bean-Mayberry BA, Change CH, McNeil MA, et al. Ensuring high-quality primary care for women: Predictors of success. Womens Health Issues 2006;16:22-9.

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