Measurements of Focal Constructs. Functional health status is conceptualized as a person’s “ability to perform self-care, self- maintenance, and physical activities”.[41] The Xxxx index is one of the main and competing ordinal indices for assessing ADL and measuring a person’s functional independence.[42] The Xxxx index is designed to assess the physical functioning of older and chronically ill patients, which includes six dichotomous ratings (dependent or independent) for each of the six ADL functions – bathing, dressing, going to the toilet, transferring from bed to chair, continence, and feeding.[43] There is a diversity of COC indices in research examining COC as well, with each index defining COC differently. The variation of these indices rely on the definitions of COC that each index entails, such as the duration of provider relationship, density of visits, dispersion of providers, sequence of providers, or subjective estimates.[21] These indices were evaluated through either survey questions or through medical claims data. As the importance of assessing COC is stressed more in the health services research for evaluation of changes in health care reforms and healthcare delivery, multiple measures of COC using claims data have been developed.[44] Among all the indices using medical claims data, Xxxx-Xxxxxxxx COC index (BB index) is a claims-based measure and was found to be feasible to implement comprehensively and efficiently for large populations.[44] The BB index mathematically indicates the dispersion of unique physicians seen by each individual across their total count of Evaluation and Management (E&M) visits.[18,21,45] Based on the validation of the BB index from previous literature, this study utilized the BB index for measuring COC in the care process of older adults with ADRD.
