Care Coordination Endorsement Maintenance 

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The Opportunity

The lack of coordination and communication across settings and between episodes of care leads to increased medical errors, higher costs, and unnecessary pain for patients. NQF has undertaken several projects to provide guidance and measurement of care coordination, including a 2006 project that yielded an endorsed definition and framework for care coordination. NQF has defined care coordination as a “function that helps ensure that the patient’s needs and preferences for health services and information sharing across people, functions, and sites that are met over time.” The framework for examining and understanding care coordination identified five key domains: healthcare “home”; proactive plan of care and follow-up; communication; information systems; and transitions or handoffs.¹  A project completed in 2010 endorsed 25 care coordination practices and 10 performance measures. Finally, NQF, in its role as the convener and a Partner of the National Priorities Partnership (NPP), supports the priorities and goals put forth in HHS’s 2011 National Quality Strategy, which include:

• Making care safer;
• Ensuring person- and family-centered care;
• Promoting effective communication and coordination of care;
• Promoting the most effective prevention and treatment of the leading causes of mortality, starting with cardiovascular disease;
• Working with communities to promote wide use of best practices to enable healthy living; and
• Making quality care more affordable.

NPP has further emphasized the following areas within the above priorities: preventable admissions and readmissions; care transitions; patient experience of care coordination; and the importance of cultural and linguistically appropriate resources and services, and communication to support patient self-management.

Care coordination is important in managing chronic conditions, for which patients often receive care in multiple settings. A study found that in 2000, Medicare beneficiaries were treated by a median of two primary care physicians and five specialists, and those with chronic conditions were treated by as many as 16 different physicians a year.³  In addition, the population living with chronic conditions is steadily increasing. In 2000, 125 million people were living with at least one chronic illness; this number is expected to grow to 157 million by 2020. By 2030, half the population will have one or more chronic conditions. Currently, half of all people with chronic conditions have multiple chronic conditions.⁴  

The clear need for coordinated care, combined with the expected increase in the numbers of people with chronic conditions, presents challenges for effective, efficient, and safe healthcare. Lack of communication and information sharing among healthcare settings can contribute to poor outcomes, including medication errors, preventable hospital readmissions, and ED visits.

About the Project

The current project has two phases. The first phase will address the implementation and methodological issues in data collection and data sharing required by effective care coordination. These issues include interoperability concerns, applicable data sources, patient self-report on coordination, and attribution to multiple providers. A commissioned paper will provide background on the data sources and readiness of health information technology (HIT) systems to support measures addressing the transitions of care and information sharing. This paper will provide information for a final report on critical paths to implementation. The second phase of this project, using information found in Phase 1, will seek to endorse performance measures for care coordination, with particular focus on the three prioritized gap areas: transitions across settings and providers, effective care planning to facilitate care, and appropriate and timely follow-up.

Objectives

The objectives of this project are two-fold:

1. In Phase 1, NQF seeks to understand implementation and methodological issues that limit measurement and quality improvement of care coordination. NQF will commission a paper to address current capabilities and data needs of electronic health records (EHRs) to support performance measures in the area of care coordination and barriers to implementing necessary elements to further such measurement.
2. In Phase 2, through its formal Consensus Development Process (CDP, Version 1.9), NQF seeks to identify and endorse measures for public reporting and quality improvement addressing care coordination. Phase 2 also will review NQF’s currently endorsed care coordination standards that are due for maintenance.

NQF Process

Measures will be considered for NQF endorsement as national voluntary consensus standards based on the recommendations developed through NQF’s formal CDP. This project involves the active participation of representation from a broad spectrum of healthcare stakeholders and will be guided by a Steering Committee.

Funding

This project is funded by the Department of Health and Human Services.

Related NQF Work

• Preferred Practices and Performance Measures for Measuring and Reporting Care Coordination (2010)
• NQF-Endorsed Definition and Framework for Measuring and Reporting Care Coordination (2006)

Contact Information

For further information, contact Lauralei Dorian at 202-783-1300 or via email at carecoordination@qualityforum.org.

Footnotes

¹ National Quality Forum (NQF), NQF-Endorsed Definition and Framework for Measuring and Reporting Care Coordination, Washington, DC; NQF 2006. Available at www.qualityforum.org/projects/care_coordination.aspx. Last accessed June 2011.

² NQF, Preferred Practices and Performance Measures for Measuring and Reporting Care Coordination. Washington, DC: NQF; 2010. Available at www.qualityforum.org/projects/care_coordination.aspx. Last accessed June 2011.

³ Pham HH, Schrag D, O’Malley AS, et al., Care patterns in Medicare and their implications for Pay for Performance, New Engl J Med, 2007;356(11):1130-1139.

⁴ Anderson, G, Chronic Care: Making the Case for Ongoing Care. Princeton, NJ: Robert Wood Johnson Foundation; 2010. Available at http://www.rwjf.org/pr/product.jsp?id=50968. Last accessed June 2011.