A Program of
Southwestern Colorado
Area Health Education Center

701 Camino del Rio, Suite 316
Durango CO 81301
(970) 426-4284
(970) 426-4285

Measures of Care Coordination

Slide041. Assessment of Chronic Illness Care (ACIC)
2. ACOVE-2 Quality Indicators: Continuity and Coordination of Care Coordination
3. Coleman Measures of Care Coordination
4. Consumer Assessment of Healthcare Providers and Systems (CAHPS)

a) Adult Primary Care 1.0
b) Adult Specialty Care 1.0
c) Child Primary Care 1.0

5. Care Coordination Measurement Tool (CCMT)
6. Client Perception of Coordination Questionnaire (CPCQ)
7. Collaborative Practice Scale (CPS)

a) Nurse Scale
b) Physician Scale

8. Breast Cancer Patient and Practice Management Process Measures
9. Care Transitions Measure (CTM)

a) CTM-3
b) CTM-15

10. Patient Assessment of Care for Chronic Conditions (PACIC)                                                                     Patient-Reported Surveys
11. Family-Centered Care Self-Assessment Tool                                                                                                    Patient Activation Measure

a) Family Version
b) Provider Version

12. ICU Nurse-Physician Questionnaire

a) Long Version
b) Short Version

13. Primary Care Assessment Survey (PCAS)
14. National Survey of Children With Special Health Care Needs (CSHCN)
15. Head And Neck Cancer Integrated Care Indicators
16. Medical Home Index (MHI)

a) Long Version (MHI-LV)
b) Short Version (MHI-SV)
c) Medical Home Family Index and Survey (MHFIS)

17. Primary Care Assessment Tool (PCAT)

a) Child Expanded Edition (PCAT-CE)
b) Adult Expanded Edition (PCAT-AE)
c) Facility Expanded Edition (PCAT – FE)
d) Provider Expanded Edition (PCAT – PE)

18. Physician-Pharmacist Collaboration Instrument (PPCI)
19. Readiness for the Patient-Centered Medical Home
20. Family Medicine Medication Use Processes Matrix (MUPM)
21. Resources and Support for Self-Management (RSSM)
22. Continuity of Care Practices Survey

a) Program Level (CCPS-P)
b) Individual Level (CCPS-I)

23. Program of All-Inclusive Care for the Elderly (PACE)
24. Measure of Processes of Care (MPOC-28)
25. Care Evaluation Scale for End-of-Life Care (CES)
26. Oncology Patients’ Perceptions of the Quality of Nursing Care Scale (OPPQNCS)
27. Care Coordination Services In Pediatric Practices
28. Collaboration and Satisfaction About Care Decisions (CSACD)
29. Follow Up Care Delivery
30. Family Satisfaction in the Intensive Care Unit (FS-ICU 24)
31. Korean Primary Care Assessment Tool (KPCAT)
32. Primary Care Multimorbidity Hassles for Veterans With Chronic Illnesses
33. Primary Care Satisfaction Survey for Women (PCSSW)
34. Personal Health Records (PHR)
35. Picker Patient Experience (PPE-15)
36. Physician Office Quality of Care Monitor (QCM)
37. Patient Perceptions of Care (PPOC)
38. PREPARED Survey

a) Patient Version
b) Carer Version
c) Residential Care Staff Version
d) Community Service Provider Version
e) Medical Practitioner Version
f) Modified Medical Practitioner Version

39. Health Tracking Household Survey
40. Adapted Picker Institute Cancer Survey
41. Ambulatory Care Experiences Survey (ACES)
42. Patient Perception of Continuity Instrument (PC)
43. Jefferson Survey of Attitudes Toward Physician-Nurse Collaboration
44. Clinical Microsystem Assessment Tool (CMAT)
45. Components of Primary Care Index (CPCI)
46. Relational Coordination Survey
47. Fragmentation of Care Index (FCI)
48. After-Death Bereaved Family Member Interview
49. Schizophrenia Quality Indicators for Integrated Care
50. Degree of Clinical Integration Measures
51. National Survey for Children’s Health (NSCH)
52. Mental Health Professional HIV/AIDS Point Prevalence and Treatment Experiences
53. Cardiac Rehabilitation Patient Referral from an Inpatient Setting
54. Cardiac Rehabilitation Patient Referral from an Outpatient Setting
55. Patients with a Transient Ischemic Event ER Visit That Had a Follow Up Office Visit
56. Biopsy Follow Up
57. Reconciled Medication List Received by Discharged Patients
58. Transition Record with Specified Elements Received by Discharged Patients (Inpatient Discharges)
59. Timely Transmission of Transition Record
60. Transition Record with Specified Elements Received by Discharged Patients (Emergency Department Discharges)
61. Melanoma Continuity of Care—Recall System
62. Team Survey for Program of All-Inclusive Care for the Elderly (PACE)
63. Medication Reconciliation for Ambulatory Care
64. Promoting Healthy Development Survey PLUS – (PHDS-PLUS)
65. Canadian Survey of Experiences with Primary Health Care Questionnaire
66. Interpersonal Processes of Care Survey
67. Brief 5 A’s Patient Survey
68. Patient Perceived Continuity of Care from Multiple Providers
69. Relational and Management Continuity Survey in Patients with Multiple Long-Term Conditions
70. Patient Perception of Integrated Care Survey (PPIC)
71. Safety Net Medical Home Scale (SNMHS)
72. Parents’ Perceptions of Primary Care – (P3C)
73. Primary Care Questionnaire for Complex Pediatric Patients
74. Safety Net Medical Home Provider Experience Survey
75. Rhode Island Physician Health Information Technology Survey
76. The Joint Commission Patient-Centered Medical Home Self-Assessment Survey
77. Communication with Referring Physicians Practice Improvement Module (CRP-PIM)
78. Safe Transitions Community Physician Office Best Practice Measures
79. National Survey of Physicians Organizations and the Management of Chronic Illness II (NSPO-2)
80. Patient-Centered Medical Home Assessment (PCMH-A) Tool



For assistance with  accessing validated instruments or measurement tools please contact Nora at [email protected]



 McDonald, K. M., Schultz, E. M., Albin, L., Pineda, N., Lonhart, J., Sundaram, V., . . . Davies, S. (2014). Care Coordination Atlas Version 4 (Prepared by Stanford University under subcontract to American Institutes for Research on Contract No. HHSA290-2010-00005I). (AHRQ Publication No.14-0037-EF). Rockville, MD.

McDonald, K., Schultz, E., Albin, L., Pineda, N., Lonhart, J., Sundaram, V., . . . Malcolm, E. (2010). Care coordination atlas version 3 (Prepared by Stanford University under subcontract to Battelle on Contract No. 290-04-0020). AHRQ Publication(11-0023).