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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1052 — Evaluating the Implementation of Models for Delivering Post-Deployment Integrated Care

Wyte T (COE-Sepulveda), MacGregor C (COE-Sepulveda), Mittman B (COE-Sepulveda)

Development of effective models for delivering integrated care remains a high priority for VHA. VHA’s Post-Deployment Integrated Care Initiative (PDICI) was launched in 2008 to improve quality of care for returning OEF/OIF Veterans via enhanced integration of mental health, social work, and other services with primary care. Recognizing the variability in VHA facilities, national PDICI program staff issued guidance for facility program design, suggesting three models: “clinic” (specialized interdisciplinary OEF/OIF clinic), “cohort” (providers designated for the care of OEF/OIF Veterans), and “consultative” (expert clinicians who provide consultation to providers on OEF/OIF issues). We examined VHA facilities’ PDICI planning and implementation processes and variations in characteristics of facilities’ PDICI programs.

We conducted 1) an in-depth comparative case study assessment of PDICI organizational arrangements in a sample of 7 VAMCs through telephone and in-person interviews with key facility leaders and staff, and 2) a national survey administered to a key stakeholder at each VA healthcare system on the topic of PDICI organizational arrangements for OEF/OIF Veterans. The case study sites were randomly selected from sampling strata comprising geographic regions and the three suggested program models.

The case studies revealed significant variations in facilities’ interpretation, planning, and implementation of PDICI arrangements. Arrangements included a) a “clinic model” providing same-day evaluations by primary care, mental health, and social work; b) a hybrid approach comprising a post-deployment evening “clinic” supplemented by daytime “cohort” providers; and c) a loose identification of designated PCPs, primarily utilized for Veterans categorized as seriously ill and injured. One facility had no special PDICI program. Care integration was strongest during the initial evaluation period compared to ongoing care. Key factors appearing to influence care arrangement decisions included OEF/OIF Veteran patient volume, and the size and attributes (e.g., level of urbanity) of the facility's catchment area.

This study contributes to emerging research about implementation of national VA initiatives, both generally and for special Veteran populations. The unique needs of the post-deployment population present the opportunity for examining integrated services around primary care.

Increased understanding of VHA facility responses to national initiatives to redesign care is critical for improving the design and implementation of future initiatives, including Patient-Aligned Care Teams (PACT).

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