Care Coordination Practices & Measures 

The Opportunity

Care coordination helps ensure a patient’s needs and preferences for care are understood, and that those needs and preferences are shared between providers, patients, and families as a patient moves from one healthcare setting to another. Care among many different providers must be well-coordinated to avoid waste, over-, under-, or misuse of prescribed medications, and conflicting plans of care. ¹  

A portfolio of care coordination preferred practices and performance measures would include structure, process, and outcome measures to evaluate physician office capacity for access, continuity, communication, and tracking of patients across providers and settings. Given the high-risk nature of transitions in care, this work would build on ongoing efforts among the medical and surgical specialty societies to establish principles for effective patient hand-offs across clinicians and providers.

 Statistics 

People with chronic conditions, like diabetes or hypertension, often receive care in multiple settings from numerous providers – they may see up to 16 physicians a year. ¹  

In 2000, 125 million people in the United States were living with at least one chronic illness, a number that is expected to grow to 157 million by 2020. The number of individuals with multiple chronic conditions is expected to reach 81 million by 2020. ²  

About the Project

In May 2006, NQF endorsed a 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 are met over time.” This project seeks to establish practices and measures to be used in evaluating care coordination.

 Objectives  

This project seeks to endorse a set of preferred practices and performance measures in care coordination that are applicable across all settings of care.

 Process 

Candidate practices and measures will be considered for NQF endorsement as national voluntary consensus standards. Agreement will be developed through NQF’s Consensus Development Process (CDP, version 1.8). This project involves the active participation of representatives from across the spectrum of healthcare stakeholders and is guided by a steering committee (PDF).

 Funding 

Support for this project has been provided by the WellPoint Foundation, Inc., Sanofi-aventis, and US Department of Veterans Affairs.

 Related NQF Work 

 NQF-Endorsed^® Definition and Framework for Measuring Care Coordination (2006)  ³  (PDF)

 Contact Information 

Nicole W. McElveen, MPH, at 202-783-1300 or carecoordination@qualityforum.org.

 Notes 

•  Bodenheimer, T, Coordinating Care – A Perilous Journey through the Health Care System, New England Journal of Medicine, March 6, 2008; 358:1064-71.
•  Bodenheimer, T, Coordinating Care – A Perilous Journey through the Health Care System, New England Journal of Medicine, March 6, 2008; 358:1064-71.
•  Endorsed in May 2006, as part of phase 3, cycle 1 of NQF’s ambulatory care project.