Performance Measures for Care
Coordination:
Strategic Actions for Nursing
American Academy of Nursing
Preconference
Hosted by the Expert Panel on Quality Health Care
October 13, 2011
Thank you to:
• Members of the Expert Panels on Quality
Health Care, Information Technology, and
Acute and Critical Care
• Reviewers
Dori Sullivan, Bonnie Wesorick, and
Madeline Schmitt
• Panel Members
Marla Weston & Bonnie Wesorick
• All of you in the audience today
A Work in Progress
Focus on ACTION
Process for Review and Endorsement
1. Review by EP members &
collaborating organization
2. AAN Board Review
3. Requests for endorsement by
collaborating organizations
Performance Measures for Care
Coordination
• Significance and Urgency for Action
- Health care system
- Patients and families
• State of Performance Measures and Gaps
• Recommendations for Action
What is care coordination?
“Care coordination is the deliberate organization of patient
care activities between two or more participants (including
the patient) involved in a patient’s care to facilitate the
appropriate delivery of health services. Organizing care
includes marshalling of personnel and other resources needed
to carry out all required patient care activities and is often
managed by the exchange of information among participants
responsible for different aspects of care.”
McDonald et al, 2010, p. 4
This definition was developed from more than 40 definitions and guided
the review and selection of measures for the AHRQ Care Coordination
Measures Atlas
Another influential definition
“Care coordination is a function that helps ensure that the
patient’s needs and preferences for health services and
information sharing across people, functions, and sites are
met over time.”
Five Domains of Care Coordination: healthcare home,
proactive plan of care and follow-up, communication,
information systems, transitions or hand-offs
NQF Framework for defining and measuring care
coordination, 2006
Significance of Measuring Care
Coordination
• Part of every current proposal and model to improve
health care outcomes and reduce costs.
• Viewed as the missing link to connect patients and
families to more appropriate services and most
appropriate time.
National Quality Strategy
Healthcare/Medical Home
NQF Measures Application
Partnership
CMS Center for Innovation
ACOs
For Patients and Families
Care coordination associated with:
Whole experience of health care
Coherent versus what is going on?
Organized versus who’s in charge here?
Manageable versus does anyone care?
Safety outcomes (e.g., med errors, falls) length of stay,
readmissions, timeliness of services, duplication of
services, gaps in services
OVERUSE and UNDERUSE
For Nursing
Care Coordination has always been core to
nursing practice
“Care coordination is one of the traditional
strengths of the nursing profession whether in
the community or the acute care setting.”
IOM, Future of Nursing, 2011, p. 65.
Care Coordination and Nursing
Practice
To a great extent, nurses and nursing care have been central,
but unrecognized and unpaid coordinators of care.
Nursing models of care coordination are deeply embedded
and core to new delivery models like healthcare/medical
homes and ACOs.
How will the nursing community proceed?
to define their care coordination practices
ensure that care coordination measures capture
nursing’s interventions in ways that demonstrate
impact on important outcomes?
Opportunities to influence Care
Coordination Performance Measurement
• Care Coordination is considered an “emerging
area of measurement with numerous
implementation challenges.” NQF, 2011.
• Moving forward with considerable intent and
speed, e.g. new delivery models, new NQF
steering committee, expect call for measures
State of Care Coordination
Performance Measures
• AHRQ CC Atlas - > 60 measures
• NQF Performance Measures for Measuring and Reporting Care
Coordination (2010)
- 10 (13%) of 77 submitted measures recommended for approval
- Only two domains – plan of care and transitions, had endorsed
measures.
- No new measures endorsed in domains of healthcare home,
communication and information systems.
- 5 of the newly endorsed measures were condition, treatment or
setting specific; 5 specific to hospital or ER transfer to home
Note: Performance measures are designed to be used for external
accountability and internal QI
Examples of NQF Endorsed Measures
2010
• Cardiac rehab patient referral from an inpatient setting
• Patients with transient ischemic event ER visit who had a
follow up office visit
• Reconciled medication list received by discharged patient
• Transition record with specified elements received by
discharged patients
• Timely transmission of transition record (inpatient discharge
to home/self care or any other site of care)
• 3-item Care Transitions Measure
Care Coordination
Performance Measures
• Most are process measures that capture a
small part of care coordination activities
• Most are provider centric and condition
specific (Naylor & Kurtzman, 2010)
• Most work on transitional care measures
• No newly endorsed measures in
communication, IS, healthcare home
Significant Gaps
• Patient and family experience of care coordination
– no measures of patient and family expectations and experience
of sequencing and integration of care
• Essential structures to support care coordination –
staffing and resource requirements not defined
• Outcomes of care coordination – no standard definition of
preventable hospitalization; examine episode of care measures
• Nursing’s Contribution – lack definition and measures, see
INQRI research findings
Priorities for Action by the Nursing
Community
1. Evaluate definitions and domains and align
with research on best practice and
outcomes of nurse care coordination
Action 1: Convene experts to review and
recommend definitions to guide calls, review
and endorsement of measures
Action 2: Fund critical review of nursing
research – core dimensions for new
frameworks
Priorities for Action
2. Develop unified plan to anticipate and
respond to calls for preferred practices and
performance measures
Action 3: Create national repository of best
practice models
Action 4: Conduct critical review of general
and specific performance measures currently
being used to evaluate outcomes of nurse care
coordination within and across settings
Priorities for Action
3. Develop a national nursing agenda for care
coordination measurement including plans for
funding development, testing, and dissemination of
a core set of nurse cc measures
Action 5: Incorporate within major trends in
performance measurement, e.g. harmonization,
general measures, patient-centered measures
Action 6: Emphasize nursing’s unique contributions from
nursing research and practice
Action 7: Track and influence the development of HIT
used to collect and report cc performance measures
Priorities for Action
4. Focus the national nursing agenda on high
value process and outcome measures
Action 8: Explicate and study the theoretical and
operational linkages between nurse cc
activities and outcomes – especially those in
evolving delivery models, e.g. avoidable
hospitalization, med errors, unnecessary
duplication of tests.
Summary of Priorities for Action
• Definitions and Domains
1. Nurse experts to review and recommend definitions to guide calls and
review of measures
2. Fund critical review – core dimensions
• Unified plan to respond to calls
3. National repository of description/evaluation of best practices in nurse cc
4. Critical review of performance measures used to evaluate outcome of
nurse cc
• National Nursing Agenda for CC Measurement
5. Incorporate major trends
6. Highlight nurses unique contributions
7. Development of HIT
• High Value Processes and Outcomes
8. Explicate and research link between nursing activities and closely
watched outcomes