Coordination of Care for Persons with Disabilities Enrolled in Medicaid Managed Care: A Conceptual Framework to Guide the Development of Measures. V. WHAT INTERMEDIATE OUTCOMES DO WE HOPE TO ACHIEVE BY MEASURING AND IMPROVING CARE COORDINATION?


Given the limitations of long-term outcomes as performance measures of care coordination in particular, it is especially important to focus on intermediate outcomes, in order to clarify our expectations regarding care coordination, indicate the causal "pathways" we assume in moving toward longer term outcomes, and give direction to practical measurement efforts. We have identified the following list of intermediate outcomes, which may not be exhaustive (Starfield 1976; Italgliata1982; Bachrach 1993; Wehmeyer1993; Kerbergen 1996, Moore, personal communication; McTaggart, personal communication):

  1. Increased patient and family participation in maintenance and improvement of their own health. For example:

    • health-related behaviors move in the right direction;
    • adherence to treatment regimens increases;
    • missed visits and failed follow-up of referrals by patients decline;
    • patient and family self-advocacy increases.
  2. Patients receive all medical care services specified in their treatment plan.

  3. Patients receive services in the least restrictive medically appropriate setting.

  4. Delays in the receipt of services (especially services needed in crisis situations) are reduced or eliminated.

  5. All providers caring for a particular patient have current information about the health and functioning of the patient, critical life events, services being provided and the patient's response to the services.

  6. Prescriptions for and delivery of treatments (including medications) that are inappropriate given other conditions and treatments being received by the patient are reduced or eliminated.

  7. Duplication of services is reduced or eliminated.

  8. Preventable use of costly services (e.g., emergency room visits, hospitalizations, nursing home placements, services for preventable complications and sequelae) is reduced or eliminated.

  9. Negative medical and psycho-social sequelae of transitions from one care setting to another are reduced.

  10. Complaints, grievances and incidence reports for this population are reduced.

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