Coordination of Care for Persons with Disabilities Enrolled in Medicaid Managed Care: A Conceptual Framework to Guide the Development of Measures. B. Why Develop A Conceptual Framework?


Researchers and funders agreed that an important step prior to developing specific measures would be to develop a conceptual framework of care coordination, with particular relevance to people with disabilities. We believe, indeed, that such a framework to define care coordination may be relevant to other groups as well, such as people with chronic conditions. But why is such a framework needed in the first place?

The primary reason is that there is little clarity or consensus about the meaning of the term "care coordination." Like many terms in health care, it is defined in different ways by different people. In addition, other terms are often used that appear to be close in meaning to "care coordination," but the extent or degree of overlap in the meaning of these terms is also unclear (Shortell 1976; Fletcher, O'Malley, Fletcher, et al. 1984; Siegel and Habel 1996; Chen, Brown, Archibald, et al. 2000).

Social scientists believe it is impossible or at least misguided to try to measure something that cannot be clearly defined. Typically, they distinguish, in the measurement development process, two phases: conceptualization and operationalization1 (Shortell 1976). This framework is part of the conceptualization phase. Operationalization involves the detailed specification of the actions (operations) needed to measure a concept in a valid and reliable manner.

In reviewing the literature in care coordination, we have come across many calls for clear conceptualization of this and related concepts (Sofaer 1998; Corrigan, personal communication; Martin, personal communication; Rosenbach 2000). For example, in the 1960s and 1970s much attention was paid to developing measures of "continuity" of care (see discussion below). Fairly quickly, participants in this process became frustrated at how many different definitions were being used for this term, and concluded that the lack of clarity and consensus about the concept of continuity was hampering measurement efforts and, in particular, making it difficult to interpret and assess the validity of research studies that often came to quite different conclusions. Policy makers, health plans, clinicians, as well as people with disability, need to be clear, when they look at data about care coordination, what it really is, and really is not, showing them about MCO performance.

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