Impact on veterans: Among Veterans with cancer, improved care coordination is an improvement of the patient experience. If we can increase our understanding of care coordination and how best measure it, we will have a new set of tools with which to monitor and meet the needs of the Veteran cancer population. Future system improvements can be evaluated based upon their consequences for care coordination. It is possible that an improved patient-provider experience of coordination may also increase timeliness and quality of care. Background: Many definitions of care coordination have been proposed. The authors of one systematic review combined common elements from many definitions to develop this working definition: Care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient's care to facilitate the appropriate delivery of health care services. From the patient perspective, coordination problems may be experienced as a lack of guidance, or unreasonable levels of effort on their part, in meeting care needs during transfers among different nodes in the health care system. Few instruments are available to measure cancer care coordination. Furthermore, prior instruments do not include items that address significant domains, including the establishment of accountability, the facilitation of transfers, and health information technology-enabled coordination. Finally, no instruments have been developed specific to cancer patients in the Veterans Health Administration who interrelate within an integrated delivery system where the phenomenon of care coordination may be experienced differently than elsewhere. Objective: The objective of the current proposal is to develop a measure with which to systematically measure cancer care coordination from the patient perspective: the Cancer Care Coordination Monitor (CCC-M). Our study group intends to test a future intervention, involving electronic health information exchange and services, which will directly target cancer care coordination among patients and providers. Emerging activities in cancer care are being targeted towards coordination. Due to the pervasiveness of coordination activities, having measures available that accurately and reliably capture the experience of coordination will be of great value in assessing the effect of these interventions. Key operational stakeholders who can make use of our findings include our VISN 11 and the VA National Program for Oncology Services. Methods: To develop the Cancer Care Coordination Monitor (CCC-M), we propose a mixed method study. First, semi-structured interviews with patients will be done to review prior coordination items and generate new items based upon missing conceptual domains, as well as unique Veteran patient experiences. Second, we will field a finalized instrument to test its validity and psychometric properties with the following approaches: (a) exploratory factor analysis to assess subscales and internal consistency, (b) test-retest processes to determine reliability, (c) concurrent predictive validity to assess correlation with continuity of care.
This project, VA Cancer Care Coordination, seeks to develop valid measures with which to systematically measure care coordination among patients diagnosed with cancer in the VA. This pilot project will used mixed methods, consisting of formative semi- structured interviews to review and generate new items, followed by field testing and psychometric evaluation of finalized instruments. Future system improvements, including electronic health information exchange, can be evaluated based upon both their intended and unintended consequences upon cancer care coordination.
