Table 2 Key measures

 HEDIS measures [67,68,69]

BP <140/90 mm Hg

A1c <8.0%

On statin if diabetic or ASCVD risk > 10%

BP by research staff, fasting labs, EHR

 Proportion of days covered [70, 71]

Ratio of the number of days the patient is covered by a mediation during a refill period

EHR

 PCC-Ca-36 [53]

Patient-centered communication: exchanging information, making decisions, fostering healing relationships, enabling patient self-management, managing uncertainty, and responding to emotions

Patient self-report survey

 Voils’ medication adherence self-report measure [72, 73] (modified)

Measure of adherence & reasons for non-adherence of medication for key CVDs

Patient self-report survey

 Haggerty et al [74] (modified) Vimalananda et al. [75] (modified)

Multiple perspectives of care coordination

Patient- and provider- survey

 FACIT-COST [76]

Cancer care-related financial toxicity

Patient self-report survey

 Objective self-report measure [77]

Amount of out-of-pocket expense on care by spending type (e.g., medication, copayments, etc.)

Patient survey

 Patient activation measure (PAM) [78]

Patient engagement

Patient self-report survey