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HSR&D Researchers Develop Online Toolkit to Improve Primary Care Coordination within VA and with Community Providers

April 3, 2020


Takeaway: VA legislation allowing more patients to seek care from community providers has complicated care coordination in VA primary care practices, in which patients already have higher rates of comorbidity than their private-sector counterparts. The Coordination Toolkit and Coaching project is expected to improve care coordination in VA primary care clinics and provide readily-applicable methods for spreading improvements throughout VA. In addition, the project will inform VA policymakers regarding what other implementation strategies, including the use of distance coaching, might influence the use of toolkits within healthcare delivery systems.

Inefficiencies in care coordination for chronic conditions are a significant source of waste in the US (e.g., $25-$45 billion in 2011). Recent VA legislation allowing more patients to seek care from community providers has further complicated care coordination in VA primary care practices, in which patients already have higher rates of comorbidity than their private-sector counterparts. The Coordination Toolkit and Coaching (CTAC) project aims to improve patients’ experience of care coordination, while also developing better methods for bringing research evidence on care coordination into routine care. In this article, investigators describe CTAC’s first phase, in which HSR&D/QUERI investigators selected tools for an online care coordination toolkit and developed a VA Intranet site to support the tools. The final Care Coordination Toolkit, available on the VA Intranet at https://vaww.visn10.portal.va.gov/sites/Toolkits/toolkit/Pages/Home.aspx (copy and paste into your browser if you have intranet access) provides access to 18 tools that remained after their selection process, as well as detailed information about the tools’ expected benefits, and the resources required for tool implementation. The 18 tools cover 5 topics: 1) managing referrals to specialty care, 2) medication management, 3) patient after-visit summary, 4) patient activation materials, and 5) provider contact information for patients.

The CTAC project is expected to improve care coordination in VA primary care clinics and provide readily-applicable methods for spreading improvements throughout VA. In addition, the project will inform VA policymakers regarding what other implementation strategies, including the use of distance coaching, might influence the use of toolkits within healthcare delivery systems.

Ganz D, Barnard J, Smith N, et al. Development of a web-based toolkit to support improvement of care coordination in primary care. Translational Behavioral Medicine. June 2018;8(3):492-502.


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