title: Development and validation of the Medical Home Care Coordination Survey for assessing care coordination in the primary care setting from the patient and provider perspectives.
abstract: BACKGROUND
  Community health centers are increasingly embracing the Patient Centered Medical Home (PCMH) model to improve quality, access to care, and patient experience while reducing healthcare costs. Care coordination (CC) is an important element of the PCMH model, but implementation and measurability of CC remains a problem within the outpatient setting. Assessing CC is an integral component of quality monitoring in health care systems. This study developed and validated the Medical Home Care Coordination Survey (MHCCS), to fill the gap in assessing CC in primary care from the perspectives of patients and their primary healthcare teams.
  
  
  METHODS
  We conducted a review of relevant literature and existing care coordination instruments identified by bibliographic search and contact with experts. After identifying all care coordination domains that could be assessed by primary healthcare team members and patients, we developed a conceptual model. Potentially appropriate items from existing published CC measures, along with newly developed items, were matched to each domain for inclusion. A modified Delphi approach was used to establish content validity. Primary survey data was collected from 232 patients with care transition and/or complex chronic illness needs from the Community Health Center, Inc. and from 164 staff members from 12 community health centers across the country via mail, phone and online survey. The MHCCS was validated for internal consistency, reliability, discriminant and convergent validity. This study was conducted at the Community Health Center, Inc. from January 15, 2012 to July 15, 2014.
  
  
  RESULTS
  The 13-item MHCCS - Patient and the 32-item MHCCS - Healthcare Team were developed and validated. Exploratory Structural Equation Modeling was used to test the hypothesized domain structure. Four CC domains were confirmed from the patient group and eight were confirmed from the primary healthcare team group. All domains had high reliability (Cronbach's α scores were above 0.8).
  
  
  CONCLUSIONS
  Patients experience the ultimate output of care coordination services, but primary healthcare staff members are best primed to perceive many of the structural elements of care coordination. The proactive measurement and monitoring of the core domains from both perspectives provides a richer body of information for the continuous improvement of care coordination services. The MHCCS shows promise as a valid and reliable assessment of these CC efforts.
authors.affiliation: Weitzman Institute, Community Health Center, Inc., Middletown, CT, USA. ZlatevI@chc1.com.
authors.forename: Ianita
authors.initials: I
authors.lastname: Zlateva
authors.affiliation: Weitzman Institute, Community Health Center, Inc., Middletown, CT, USA. Daren@chc1.com.
authors.forename: Daren
authors.initials: D
authors.lastname: Anderson
authors.affiliation: Ethel Donaghue TRIPP Center, University of Connecticut Health Center, Farmington, CT, USA. Coman@uchc.edu.
authors.forename: Emil
authors.initials: E
authors.lastname: Coman
authors.affiliation: Weitzman Institute, Community Health Center, Inc., Middletown, CT, USA. KhatriK@chc1.com.
authors.forename: Khushbu
authors.initials: K
authors.lastname: Khatri
authors.affiliation: Weitzman Institute, Community Health Center, Inc., Middletown, CT, USA. TerryTian1988@gmail.com.
authors.forename: Terrence
authors.initials: T
authors.lastname: Tian
authors.affiliation: Ethel Donaghue TRIPP Center, University of Connecticut Health Center, Farmington, CT, USA. fifield@uchc.edu.
authors.forename: Judith
authors.initials: J
authors.lastname: Fifield
mesh_terms: D000328:Adult; D000368:Aged; D003151:Community Health Centers; D003266:Continuity of Patient Care; D003695:Delivery of Health Care; D005260:Female; D019538:Health Care Surveys; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D011320:Primary Health Care; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult