A Concise Tool for Measuring Care Coordination from the Provider’s Perspective in the Hospital Setting
BACKGROUND: To support hospital efforts to improve coordination of care, a tool is needed to evaluate care coordination from the perspective of inpatient healthcare professionals.
OBJECTIVES: To develop a concise tool for assessing care coordination in hospital units from the perspective of healthcare professionals, and to assess the performance of the tool in measuring dimensions of care coordination in 2 hospitals after implementation of a care coordination initiative.
METHODS: We developed a survey consisting of 12 specific items and 1 global item to measure provider perceptions of care coordination across a variety of domains, including teamwork and communication, handoffs, transitions, and patient engagement. The questionnaire was distributed online between October 2015 and January 2016 to nurses, physicians, social workers, case managers, and other professionals in 2 tertiary care hospitals.
RESULTS: A total of 841 inpatient care professionals completed the survey (response rate = 56.6%). Among respondents, 590 (75%) were nurses and 37 (4.7%) were physicians. Exploratory factor analysis revealed 4 subscales: (1) Teamwork, (2) Patient Engagement, (3) Handoffs, and (4) Transitions (Cronbach’s alpha 0.84-0.90). Scores were fairly consistent for 3 subscales but were lower for patient engagement. There were minor differences in scores by profession, department, and hospital.
CONCLUSION: The new tool measures 4 important aspects of inpatient care coordination with evidence for internal consistency and construct validity, indicating that the tool can be used in monitoring, evaluating, and planning care coordination activities in hospital settings.
© 2017 Society of Hospital Medicine
Care Coordination has been defined as “…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 healthcare services.”1 The Institute of Medicine identified care coordination as a key strategy to improve the American healthcare system,2 and evidence has been building that well-coordinated care improves patient outcomes and reduces healthcare costs associated with chronic conditions.3-5 In 2012, Johns Hopkins Medicine was awarded a Healthcare Innovation Award by the Centers for Medicare & Medicaid Services to improve coordination of care across the continuum of care for adult patients admitted to Johns Hopkins Hospital (JHH) and Johns Hopkins Bayview Medical Center (JHBMC), and for high-risk low-income Medicare and Medicaid beneficiaries receiving ambulatory care in targeted zip codes. The purpose of this project, known as the Johns Hopkins Community Health Partnership (J-CHiP), was to improve health and healthcare and to reduce healthcare costs. The acute care component of the program consisted of a bundle of interventions focused on improving coordination of care for all patients, including a “bridge to home” discharge process, as they transitioned back to the community from inpatient admission. The bundle included the following: early screening for discharge planning to predict needed postdischarge services; discussion in daily multidisciplinary rounds about goals and priorities of the hospitalization and potential postdischarge needs; patient and family self-care management; education enhanced medication management, including the option of “medications in hand” at the time of discharge; postdischarge telephone follow-up by nurses; and, for patients identified as high-risk, a “transition guide” (a nurse who works with the patient via home visits and by phone to optimize compliance with care for 30 days postdischarge).6 While the primary endpoints of the J-CHiP program were to improve clinical outcomes and reduce healthcare costs, we were also interested in the impact of the program on care coordination processes in the acute care setting. This created the need for an instrument to measure healthcare professionals’ views of care coordination in their immediate work environments.
We began our search for existing measures by reviewing the Coordination Measures Atlas published in 2014.7 Although this report evaluates over 80 different measures of care coordination, most of them focus on the perspective of the patient and/or family members, on specific conditions, and on primary care or outpatient settings.7,8 We were unable to identify an existing measure from the provider perspective, designed for the inpatient setting, that was both brief but comprehensive enough to cover a range of care coordination domains.8
Consequently, our first aim was to develop a brief, comprehensive tool to measure care coordination from the perspective of hospital inpatient staff that could be used to compare different units or types of providers, or to conduct longitudinal assessment. The second aim was to conduct a preliminary evaluation of the tool in our healthcare setting, including to assess its psychometric properties, to describe provider perceptions of care coordination after the implementation of J-CHiP, and to explore potential differences among departments, types of professionals, and between the 2 hospitals.
METHODS
Development of the Care Coordination Questionnaire
The survey was developed in collaboration with leaders of the J-CHiP Acute Care Team. We met at the outset and on multiple subsequent occasions to align survey domains with the main components of the J-CHiP acute care intervention and to assure that the survey would be relevant and understandable to a variety of multidisciplinary professionals, including physicians, nurses, social workers, physical therapists, and other health professionals. Care was taken to avoid redundancy with existing evaluation efforts and to minimize respondent burden. This process helped to ensure the content validity of the items, the usefulness of the results, and the future usability of the tool.
