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

  1. Keep in mind that this is of concern to social scientists, in particular, because they are typically not measuring the characteristics of objects and readily observable events (such as the height of a table or how rapidly an apple falls from a tree), but rather abstract concepts (such as personal autonomy or health care quality).

  2. The Institute of Medicine is embarked, as part of its effort "Quality of Health Care in America," on an attempt to specify the "chassis" needed to drive quality in the health care delivery system in the years to come. This chassis will attend to such broader issues as organization, financing, professional education, information system development, and the role of the patient/consumer. Given the participation of IOM staff on our Technical Advisory Group (TAG) and Technical Expert Panel (TEP), we hope to learn from their endeavors as we proceed.

  3. They are, of course, likely to need accommodations from the health care delivery system in order to make effective use of its resources, but that is not the same thing as care coordination.

  4. The exception the TAG made was that some measures may be relevant specifically to children.

  5. An important exception are protocols built around the concept of "patient self-management" of chronic conditions, such as those developed and used at the Group Health Cooperative of Puget Sound.

  6. Provider experience may decrease with more coordination. Especially for physicians. It may create more work to communicate with others about things they may not know much about.

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