The Clinical Community Relationships Measures (CCRM) Atlas “defines, measures, and evaluates” programs relying on clinical-community relationships in order to deliver clinical preventive services. The CCRM Atlas was developed for Agency for Healthcare Research and Quality (AHRQ) as a means to improve primary care through a preventive and chronic care program.
Geography: United States; Focus Area: Deployment of preventive services through clinician-community connections
The approaches detailed in the CCRM Atlas enable community-based organizations to cooperate, coordinate, and collaborate in the delivery of preventive care services in clinical settings. Important components of the CCRM Atlas include a measurement framework (measures of clinical-community relationships), interventions to improve research, quality, and delivery of clinical preventive services.
The CCRM Atlas for Enabling Preventive Services through Clinical-Community Connections
The CCRM Atlas provides a rationale and recommendations to deliver preventive services without insurance cost-sharing, to address high costs of healthcare and morbidity rates. Several barriers exist for the delivery of preventive services in primary care settings, such as staffing shortage, time constraints, and problems with reimbursements.
The delivery of these services may be possible through successful partnerships of primary care providers with community-based organizations and local health departments (non-clinical organizations with shared interests).
The CCRM measurement framework (defining clinical-community relationships to deliver preventive care) includes a structure, process, and outcome measures. It defines the characteristics of patients, clinicians, and community organizations, and their relationships and interactions.
An example of a clinical-community relationship is when a primary care provider makes a connection with a a community resource to provide a preventive service such as tobacco screening and counseling. The clinical setting and community resource then work together with at least one of the Himmelman strategies i.e. coordinating, cooperating, networking, and collaborating.
There is a distinction between care coordination and clinical-community relationships in that the former happens between healthcare organizations, while the latter is a subset of care coordination happening between community-based resources (not considered healthcare organizations) and clinics. In this regard, the Expanded Chronic Care Model provides a broader context, with a clinician supported by a team of care professionals with diverse roles.
Key Elements of the AHRQ CCRM Framework
Characteristics for and m “foundational anchors” on each side of the bridge of a clinical-community relationship, form one dimension of the framework. The other dimension is the Donabedian’s structure-process-outcome model.
Different measurement domains are defined such as access to primary care or community resource, service delivery, clinician experience, communication, follow-up, and feedback, familiarity with community resource, marketing, organizational structure, patient centeredness and experience, shared decision-making, timeliness, training, and many more.
Measurement frameworks also have contexts within which the clinician, community resource, and patient exist, and are influenced by many other factors. The elements defined by the framework may differ from community to community owing to their wealth, population size, cultural diversity, educational attainment, challenges faced and coping strategies. Health and community resources available in a community influence relationships between patient and clinician. Patients are affected by their characteristics, family structure, organizational environment, and community policies.
Measures of structure, process, and outcomes may be examined at six different points - the clinic/clinician, patient, community resource elements, and the three intersections i.e. patient-clinician, clinician-community resource, and patient-community resource.
Promotion: Community Palliative Care and COVID-19: A handbook for clinicians who care for palliative patients with COVID-19 in community settings Kindle Edition by Tania Blackmore (Author), Georgina Parker (Author)
Definition of Structure-Process-Outcome Measures
AHRQ CCRM Atlas defines three examples of implementing measures within a specific framework. An example of a structure domain within a measurement framework is that of a primary care clinic with an IT infrastructure that makes electronic referrals to a community center. In this case, measures of infrastructure are placed within the IT infrastructure domain. Further, a community organization delivering allied health services (mental health, substance abuse counseling) may have increased capacity to deliver preventive services. In this case, the measures of capacity are placed within the service capacity domain. Thirdly, a patient may not be able to access a community resource either due to an inability to travel or time constraints. The prevalence of such barriers may be measured through the ability to access the community resource domain.
In the process domain, a clinician may undertake work to acquire knowledge of existing community resources. These measures may be placed under outreach to obtain knowledge and familiarity with community resources. Furthermore, marketing activities for promoting patient and clinician may be placed under the marketing of services domain.
Finally, in the outcome domain, a physician may collaborate with a community organization to provide preventive services to have more time to see patients in a typical work week. These measures may be placed under cost and efficiency domain. Further, a patient receiving behavioral counseling through a community organization where they have been referred may be measured for rate of completion of counseling services under the delivery of service domain.
Delivering Effective Clinical-Community Relationships for Positive Patient Outcomes
Interactions between the elements of the framework are integral to effective clinical-community relationships. The clinician at the primary care clinic initiates clinical-community liaison, measured under the delivery system design domain. The patient may be affected by factors outside the relationship with the clinician or community, which may be measured under the patient’s ability to access community resource. A community resource constituting a range of programs and organizations providing patient services must maintain the necessary resources and staffing, which may be measured under the service capacity domain. Clinical-patient relationships define level of trust and an understanding of needs and expectations, measured under informed and activated patient domain. Clinical-community relationships are formed on the basis of common benefit, and establishing routines that produce positive cost-benefit ratio, effective service delivery, efficiency and sustainability, and may be measured under nature and strength of inter-organizational relationship domain. Finally, the patient-community resource relationship involves patient engagement with community resource to provide appropriate preventive services, and may be measured using informed and activated patient and ready community resource domains.
To sum it all up, the CCRM Atlas is a comprehensive resource that defines a roadmap for executing preventive care through a clinician-community resource relationship. By defining core measurements in terms of structure, process, and outcome, the CCRM framework facilitates a broad range of domains and relationships to work in a collaborative manner and maximize positive patient outcomes in the long run.
Promotion: The Social Norms Approach to Preventing School & College Age Substance Abuse - A Handbook for Educators, Counselors & Clinicians: A Handbook for Educators, Counselors, and Clinicians Hardcover – Import, 11 March 2003 by HW Perkins (Author)
Keywords
AHRQ CCRM Atlas, clinician-community relationship, chronic care model, measure of clinical-community relationships. structure process outcome measures, preventive care, positive patient outcomes
References
Westat, & Oregon Rural Practice-based Research Network (ORPRN). (2013). Clinical-Community Relationships Measures (CCRM) Atlas. In www.ahrq.gov. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/prevention/resources/chronic-care/clinical-community-relationships-measures-atlas/index.html
No comments:
Post a Comment