Measuring Primary Care Organizational Capacity for Diabetes Care Coordination: The Diabetes Care Coordination Readiness Assessment

BACKGROUND

Not all primary care clinics are prepared to implement care coordination services for chronic conditions, such as diabetes. Understanding true capacity to coordinate care is an important first-step toward establishing effective and efficient care coordination. Yet, we could identify no diabetes-specific instruments to systematically assess readiness and/or status of primary care clinics to engage in diabetes care coordination.

OBJECTIVE

This report describes the development and initial validation of the Diabetes Care Coordination Readiness Assessment (DCCRA), which is intended to measure primary care clinic readiness to coordinate care for adult patients with diabetes.

DESIGN

The instrument was developed through iterative item generation within a framework of five domains of care coordination: Organizational Capacity, Care Coordination, Clinical Management, Quality Improvement, and Technical Infrastructure.

PARTICIPANTS

Validation data was collected on 39 primary care clinics.

MAIN MEASURES

Content validity, inter-rater reliability, internal consistency, and construct validity of the 49-item instrument were assessed.

KEY RESULTS

Inter-rater agreement indices per item ranged from 0.50 to 1.0. Cronbach’s alpha of the entire instrument was 0.964, and for the five domain scales ranged from 0.688 to 0.961. Clinics with existing care coordinators were rated as more ready to support care coordination than clinics without care coordinators for the entire DCCRA and for each domain, supporting construct validity.

CONCLUSIONS

As providers increasingly attempt to adopt patient-centered approaches, introduction of the DCCRA is timely and appropriate for assisting clinics with identifying gaps in provision of care coordination services. The DCCRA’s strengths include promising psychometric properties. A valid measure of diabetes care coordination readiness should be useful in diabetes program evaluation, assistance with quality improvement initiatives, and measurement of patient-centered care in research.     

Diabetes Care Providers’ Manual for Disaster Diabetes Care

To ensure that experiences and lessons learned from the unprecedented 2011 Great East Japan Earthquake are used to improve future disaster planning, the Japan Diabetes Society (JDS) launched the “Research and Survey Committee for Establishing Disaster Diabetes Care Systems Based on Relevant Findings from the Great East Japan Earthquake” under the supervision of the Chairman of the JDS. The Committee conducted a questionnaire survey among patients with diabetes, physicians, disaster medical assistance teams (DMATs), nurses, pharmacists, and nutritionists in disaster areas about the events they saw happening, the situations they found difficult to handle, and the needs that they felt required to be met during the 2011 Great East Japan Earthquake. A total of 3,481 completed questionnaires were received. Based on these and other experiences and lessons reported following the 2011 Great East Japan Earthquake and the 2004 Niigata‐Chuetsu Earthquakes, the current “Manual for Disaster Diabetes Care” has been developed by the members of the Committee and other invited authors from relevant specialties. To our knowledge, the current Manual is the world's first to focus on emergency diabetes care, with this digest English version translated from the Japanese original. It is sincerely hoped that patients with diabetes and healthcare providers around the world will find this manual helpful in promoting disaster preparedness and implementing disaster relief.     

Care Coordination in Cirrhosis

Purpose of Review

Care coordination involves the process of care delivery. Patients with decompensated cirrhosis represent a population with high care coordination needs. The goal of this review is to analyze the utility of care coordination strategies in cirrhosis.

Recent Findings

Target areas for care coordination strategies include transitions through care locations and disease trajectories, provider and patient communication, provider’s roles, and care delivery models. Cirrhosis research has primarily been focused on improving adherence to guideline-based care and clinical outcomes. Discrete process approaches are a reasonable place to start; however, interventions that include multidisciplinary care, patient involvement, and system redesign have greater widespread effect.

Summary

Significant gaps and unanswered questions exist, calling for a larger focus on care coordination among quality improvement initiatives in cirrhosis. Patient, provider, and economic outcomes warrant further evaluation in future studies.