Care coordination is a critical aspect of effective healthcare, ensuring that patients receive seamless and integrated services. To optimize care coordination, healthcare professionals and systems rely on robust assessment tools. This article delves into several key Care Coordination Assessment Tools, providing an in-depth look at their purpose, structure, and application in enhancing patient care. We will explore the Care Coordination Measurement Tool (CCMT), the Client Perception of Coordination Questionnaire (CPCQ), and the Collaborative Practice Scales (CPS) for nurses and physicians, offering a comprehensive understanding of these valuable instruments.
Care Coordination Measurement Tool (CCMT)
The Care Coordination Measurement Tool (CCMT) is designed to gather detailed information on care coordination encounters. Its primary purpose is to determine the cost-effectiveness of care coordination by collecting data on activities, resource utilization, outcomes, and time spent during these encounters. Care coordination encounters are broadly defined as any action taken by primary care office staff that contributes to the creation or execution of a patient or family’s care plan.
Format and Data Source: The CCMT utilizes a written form, strategically placed at office workstations. Healthcare providers and staff complete this form immediately after a care coordination encounter. Training is provided to ensure consistent and accurate form completion.
Date of Release: The CCMT was introduced in 2004, marking a significant step in formalizing care coordination assessment.
Perspective: This tool is designed from the Health Care Professional(s) perspective, capturing their direct experiences and activities in care coordination.
Measure Item Mapping: The CCMT comprehensively maps various aspects of care coordination activities, including:
- Establish accountability or negotiate responsibility: Primarily focused on staff roles.
- Communication: This is extensively covered, including communication:
- Between healthcare professionals and patients/families.
- Within teams of healthcare professionals.
- Across different healthcare teams or settings.
- General communication where participants are unspecified.
- Information transfer: Addresses information exchange in general care coordination processes.
- Facilitate transitions: Specifically looks at transitions across different settings and as patient needs evolve.
- Assess needs and goals: Evaluates the processes of needs and goals assessment.
- Create a proactive plan of care: Measures activities related to developing care plans.
- Monitor, follow up, and respond to change: Tracks ongoing monitoring and response mechanisms.
- Support self-management goals: Assesses support for patient self-management.
- Link to community resources: Examines the integration of community resources into care plans.
- Align resources with patient and population needs: Evaluates resource alignment with patient and population requirements.
- Care management: Specifically addresses care management approaches.
Development and Testing: The CCMT underwent pilot testing in diverse pediatric practices, varying in size, location, patient demographics, and care coordination models. The tool proved effective in documenting care coordination activities within the daily operations of these practices. However, due to variations in practice types and study methodologies, statistical comparisons across practices were not conducted.
Link to Outcomes or Health System Characteristics: Utilizing the CCMT provides valuable outcomes-based data on cost trends, resource utilization, and patient characteristics linked to care coordination activities, particularly for children with special healthcare needs. It helps identify associations between patient complexity and care coordination time, encounter frequency, and required care coordination types. The CCMT data also allows for estimations of annual care coordination costs and average costs per activity.
Logic Model/Conceptual Framework: The original sources do not describe a specific logic model or conceptual framework for the CCMT.
Past or Validated Applications:
- Patient Age: Primarily used for children.
- Patient Condition: Applied to children with combined chronic conditions, special healthcare needs, and in general pediatric populations, including cardiology ambulatory care and cleft lip and palate care.
- Setting: Used in primary care facilities and other outpatient specialty care settings.
Notes: The CCMT is a comprehensive instrument with 76 items, of which 56 are mapped to care coordination activities. The full instrument items are available in the appendix of the source article for detailed review.
Client Perceptions of Coordination Questionnaire (CPCQ)
The Client Perceptions of Coordination Questionnaire (CPCQ) takes a different approach by focusing on the patient’s experience. Its purpose is to measure patient-centered care and care coordination from the consumer perspective. This tool is vital for understanding how patients perceive the coordination of their healthcare journey.
Format and Data Source: The CPCQ is a 31-item, written, self-administered survey. It covers six key domains of care coordination:
- Identification of need
- Access to care
- Patient participation
- Patient-provider communication
- Inter-provider communication
- Global assessment of care
These domains are assessed across four areas of healthcare provision: overall care, general practitioner (GP) care, nominated provider care, and care for carers. Responses are collected using Likert scales.
Date of Release: The CPCQ was released in 2003, offering a patient-centric perspective on care coordination.
Perspective: The CPCQ is designed from the Patient/Family perspective, capturing their direct experiences and perceptions of care coordination.
Measure Item Mapping: The CPCQ maps to various care coordination activities, focusing on patient-centered aspects:
- Establish accountability or negotiate responsibility: Addresses patient perception of accountability in their care.
- Communication: Covers communication:
- Between healthcare professionals and patients/families.
- Across healthcare teams or settings, ensuring information flow from the patient’s viewpoint.
- Interpersonal communication: Focuses on the quality of interpersonal communication between healthcare professionals and patients/families.
- Information transfer: Assesses the effectiveness of information transfer:
- Between healthcare professionals and patients/families.
- Across healthcare teams or settings, as perceived by the patient.
- Assess needs and goals: Evaluates patient perception of needs and goals assessment processes.
- Create a proactive plan of care: Measures patient perception of their involvement in care planning.
- Monitor, follow up, and respond to change: Assesses patient experience of monitoring and responsiveness to their changing needs.
- Support self-management goals: Evaluates patient perception of support for their self-management efforts.
- Align resources with patient and population needs: Addresses patient perception of resource alignment.
- Teamwork focused on coordination: Assesses patient view of teamwork in their care coordination.
- Medication management: Includes items related to patient perception of medication management coordination.
Development and Testing: The CPCQ was developed through an iterative process of item generation. Testing showed excellent completion and comprehension rates, and its applicability across chronically ill populations. Principle components analysis identified six scales: acceptability, received care, GP, nominated provider, client comprehension, and client capacity. Construct validity, comprehensibility, and internal consistency were demonstrated for most scales. Patients with chronic pain reported significantly poorer experiences across all items, further supporting construct validity. While individual items were relevant to care coordination, further testing and potential revisions were suggested by the authors. Testing involved data from 1193 survey responses in the Australian Coordinated Care Trials.
Link to Outcomes or Health System Characteristics: The original sources do not explicitly link the CPCQ to specific health outcomes or system characteristics.
Logic Model/Conceptual Framework: No specific logic model or conceptual framework is described in the sources for the CPCQ.
Country of Origin: Australia.
Past or Validated Applications:
- Patient Age: Adults and older adults.
- Patient Condition: Used with patients having combined, general, or multiple chronic conditions, and in general populations without specific conditions.
- Setting: Primary care facilities and other outpatient specialty care facilities.
Notes: The CPCQ includes 31 items, with 23 mapped to care coordination activities, providing a focused yet comprehensive patient perspective. The full instrument items are available in the appendix of the source article for detailed examination.
Collaborative Practice Scale (CPS) – Nurse Scale & Physician Scale
The Collaborative Practice Scale (CPS) is designed to evaluate the collaboration dynamics between nurses and physicians, crucial for effective care coordination within healthcare teams. There are two versions: the Nurse Scale and the Physician Scale, each offering a unique perspective on interprofessional collaboration.
Purpose: Both the Nurse Scale and Physician Scale of the CPS aim to assess the interactions between nurses and physicians during typical care delivery processes. Collaboration, in this context, is defined as interactions that enable the synergistic use of knowledge and skills from both professions to enhance patient care.
Format and Data Source:
- Nurse Scale: A 9-item, self-administered, written survey answered on a 6-point Likert scale. Higher scores indicate greater collaboration. It focuses on communication and clarification of responsibilities.
- Physician Scale: A 10-item, self-administered, written survey, also using a 6-point Likert scale. Similar to the Nurse Scale, higher scores reflect stronger collaboration, focusing on communication and responsibility clarification.
Date of Release: Both scales were released in 1985, marking an early effort to quantify interprofessional collaboration in healthcare.
Perspective: Both CPS scales are designed from the Health Care Professional(s) perspective, specifically targeting nurses and physicians to assess their collaborative practices.
Measure Item Mapping:
CPS – Nurse Scale:
- Establish accountability or negotiate responsibility: Items assess clarity and negotiation of responsibilities within nurse-physician teams.
- Communication: Focuses on communication within healthcare professional teams.
- Interpersonal communication: Assesses interpersonal aspects of communication within these teams.
- Teamwork focused on coordination: Overall, the scale measures teamwork effectiveness in care coordination.
CPS – Physician Scale:
- Establish accountability or negotiate responsibility: Items relate to how physicians perceive accountability and responsibility negotiation.
- Communication: Includes communication between healthcare professionals and patients/families, and within healthcare professional teams.
- Interpersonal communication: Focuses on interpersonal communication within teams.
- Create a proactive plan of care: Includes items related to collaborative care planning.
- Teamwork focused on coordination: The scale comprehensively measures teamwork in care coordination from a physician’s viewpoint.
Development and Testing: Both scales were tested with a sample of 94 physicians. Significant test-retest reliability and construct validity were established. Factor analysis confirmed two distinct factors measuring collaboration components. Concurrent validity was tested against the Management of Differences Exercise (MODE) and the Health Role Expectation Index (HREI), with correlation found only with HREI. Predictive validity, assessed through peer reviews, did not show adequate validity correlations for the Nurse Scale, suggesting a need for further testing.
Link to Outcomes or Health System Characteristics: Measure developers suggest that further research is needed to link theory-based factors related to these instruments to specific outcomes.
Logic Model/Conceptual Framework: No logic model or conceptual framework is described in the sources for either CPS scale.
Country of Origin: United States.
Past or Validated Applications:
- Patient Age: Not applicable as it focuses on professional interactions.
- Patient Condition: Not applicable as it assesses team dynamics, not patient conditions.
- Setting: Not setting-specific, designed for general application in healthcare settings.
Notes:
- CPS – Nurse Scale: Contains 9 items, all mapped to collaborative practice elements. Instrument items are in Table 1 of the source article.
- CPS – Physician Scale: Contains 10 items, all mapped. Instrument items are also in Table 1 of the source article.
Conclusion
These care coordination assessment tools – CCMT, CPCQ, and CPS (Nurse and Physician Scales) – represent diverse approaches to evaluating and enhancing care coordination. The CCMT offers a healthcare provider-centric, cost-focused analysis, while the CPCQ provides crucial patient-reported perspectives. The CPS scales delve into interprofessional dynamics between nurses and physicians. Using these tools can lead to improved care processes, better patient experiences, and more effective healthcare delivery overall. By understanding and applying these care coordination assessment tools, healthcare systems can strive for more integrated, patient-centered, and efficient care.
