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Setting Standards at the Forefront of Delivery System Reform: Aligning Care Coordination Quality Measures for Multiple Chronic Conditions

DuGoff, Eva H.; Dy, Sydney; Giovannetti, Erin R.; Leff, Bruce; Boyd, Cynthia M.

The Journal for Healthcare Quality (JHQ): September-October 2013 - Volume 35 - Issue 5 - p 58–69
doi: 10.1111/jhq.12029
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Abstract: The primary study objective is to assess how three major health reform care coordination initiatives (Accountable Care Organizations, Independence at Home, and Community-Based Care Transitions) measure concepts critical to care coordination for people with multiple chronic conditions. We find that there are major differences in quality measurement across these three large and politically important programs. Quality measures currently used or proposed for these new health reform-related programs addressing care coordination primarily capture continuity of care. Other key areas of care coordination, such as care transitions, patient-centeredness, and cross-cutting care across multiple conditions are infrequently addressed. The lack of a comprehensive and consistent measure set for care coordination will pose challenges for healthcare providers and policy makers who seek, respectively, to provide and reward well-coordinated care. In addition, this heterogeneity in measuring care coordination quality will generate new information, but will inhibit comparisons between these care coordination programs.

For more information on this article, contact Eva H. DuGoff atedugoff@jhsph.edu.

Eva H. DuGoff, MPP, is a doctoral candidate in health services research and policy in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD. Her research focuses on issues related to Medicare, care coordination, and quality of care for people with multiple chronic conditions.

Sydney Dy, MD, is an Associate Professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD. She holds a joint appointment in the Departments of Oncology and Medicine in the Johns Hopkins University School of Medicine. Her areas of interest are in quality of care, safety, and decision-making research, particularly in patients with serious and terminal illness and with a focus in cancer. She is particularly interested in improving health systems and services in order to increase the appropriateness of technology and medication use.

Erin R. Giovannetti, PhD, is a Research Scientist in the Performance Measurement Department at NCQA. Dr. Giovannetti's work focuses on developing healthcare performance measures for older adults and vulnerable populations. She leads efforts to develop and evaluate performance measures for the Medicare advantage population. Dr. Giovannetti also has worked extensively with patient-reported outcomes and their use for quality assessment. Her research to date has explored how patient and family reported measures can be used for quality improvement through standardized measurement tools. Prior to joining NCQA, Dr. Giovannetti completed a fellowship at Johns Hopkins School of Medicine in the Division of Geriatric Medicine and Gerontology.

Bruce Leff, MD, is a Professor of Medicine at the Johns Hopkins University School of Medicine. He holds a joint appointment in the Department of Health Policy and Management at the Bloomberg School of Public Health, Johns Hopkins University. He is the Director of the Center on Aging and Health (COAH) Program in Geriatric Health Services Research and the Co-director of the Elder House Call Program in the Division of Geriatric Medicine at the Johns Hopkins University School of Medicine. His principal areas of research relate to the development, evaluation, and dissemination of novel models of care for older adults, including the Hospital at Home model of care (www.hospitalathome.org), Guided Care (www.guidedcare.org), geriatric service line models (www.med-ic.org), and medical house call practices. In addition, his research interests include multimorbidity, case-mix issues, and quality measure development.

Cynthia M. Boyd, MD MPH, is an Associate Professor of Medicine in the Division of Geriatric Medicine and Gerontology at the Johns Hopkins University School of Medicine with a joint appointment in Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. Dr. Boyd is a core faculty member at the Johns Hopkins Center on Aging and Health and the Roger C. Lipitz Center for Integrated Health Care. Dr. Boyd's primary areas of inquiry relate to improving health and healthcare for older adults with multimorbidity. Her research has focused on multimorbidity, the use of clinical practice guidelines and quality standards in older adults with multimorbidity, and interventions to improve care for older adults with multimorbidity.

Grant sponsor: HHS; Grant Number: #HHSM-500–2009–0010C.

© 2013 National Association for Healthcare Quality
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