Development and testing of indicators to measure coordination of clinical information and management across levels of care.
BACKGROUND
Coordination across levels of care is becoming increasingly important due to rapid advances in technology, high specialisation and changes in the organization of healthcare services; to date, however, the development of indicators to evaluate coordination has been limited. The aim of this study is to develop and test a set of indicators to comprehensively evaluate clinical coordination across levels of care.


METHODS
A systematic review of literature was conducted to identify indicators of clinical coordination across levels of care. These indicators were analysed to identify attributes of coordination and classified accordingly. They were then discussed within an expert team and adapted or newly developed, and their relevance, scientific soundness and feasibility were examined. The indicators were tested in three healthcare areas of the Catalan health system.


RESULTS
52 indicators were identified addressing 11 attributes of clinical coordination across levels of care. The final set consisted of 21 output indicators. Clinical information transfer is evaluated based on information flow (4) and the adequacy of shared information (3). Clinical management coordination indicators evaluate care coherence through diagnostic testing (2) and medication (1), provision of care at the most appropriate level (2), completion of diagnostic process (1), follow-up after hospital discharge (4) and accessibility across levels of care (4). The application of indicators showed differences in the degree of clinical coordination depending on the attribute and area.


CONCLUSIONS
A set of rigorous and scientifically sound measures of clinical coordination across levels of care were developed based on a literature review and discussion with experts. This set of indicators comprehensively address the different attributes of clinical coordination in main transitions across levels of care. It could be employed to identify areas in which health services can be improved, as well as to measure the effect of efforts to improve clinical coordination in healthcare organizations.
Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, 08022, Barcelona, Spain. maller@consorci.org.
Marta-Beatriz
MB
Aller
Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, 08022, Barcelona, Spain. ivargas@consorci.org.
Ingrid
I
Vargas
Grup de Recerca en Serveis Sanitaris i Resultats en Salut, Serveis de Salut Integrats Baix Empordà, Carrer Hospital, 17-19 Edif. Fleming, 17230, Palamós, Spain. jcoderch@ssibe.cat.
Jordi
J
Coderch
Catalan Health Institute, Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain. scalerom@gencat.cat.
Sebastià
S
Calero
IMIM - Hospital del Mar Medical Research Institute, Carrer Dr. Aiguader, 88, 08003, Barcelona, Spain. FCots@parcdesalutmar.cat.
Francesc
F
Cots
Institut de Prestacions d'Assistència Mèdica al Personal Municipal, Carrer Viladomat, 127, 08015, Barcelona, Spain. 107@pamem.org.
Mercè
M
Abizanda
Centre Integral de Salut Cotxers, Avinguda de Borbó, 18 - 30, 08016, Barcelona, Spain. jfarre@consorci.org.
Joan
J
Farré
Health Policy and Health Services Research Group; Division of Management, Planning and Organizational Development, Badalona Healthcare Services, Via Augusta, 9-13, 08911, Badalona, Spain. jrllopart@bsa.cat.
Josep Ramon
JR
Llopart
Health Policy and Health Services Research Group; Strategic Planning Division, SAGESSA Group, Avinguda del Dr. Josep Laporte, 2, 43204, Reus, Spain. llcolomes@grupsagessa.com.
Lluís
L
Colomés
Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, 08022, Barcelona, Spain. mlvazquez@consorci.org.
María Luisa
ML
Vázquez
D003266:Continuity of Patient Care; D003430:Cross-Sectional Studies; D006801:Humans; D019451:Information Management / Q000458:organization & administration*; D011786:Quality Control; D012189:Retrospective Studies