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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1042 — Slamdunks, Roadblocks, and Workarounds: Case Studies from the Frontlines of Patient-Aligned Care Teams

True G, VISN 4 Center for Evaluation of Patient Aligned Care Teams (CEPACT), Philadelphia VAMC, and University of Pennsylvania School of Medicine; Butler ALamparska B, and Lempa M, VISN 4 CEPACT, Philadelphia VAMC; Shea J, University of Pennsylvania School of Medicine; Werner R, VISN 4 CEPACT, Philadelphia VAMC and University of Pennsylvania School of Medicine;

VHA has undertaken an ambitious plan to transform all of primary care to a Patient Aligned Care Team (PACT) model, and funded a number of research teams to simultaneously evaluate implementation and measure the impact of PACT activities on processes of care and patient outcomes. This presentation discusses findings from the VISN 4 Center for Evaluation of PACT (CEPACT), with a focus on qualitative case examples from the frontlines of PACT implementation that illustrate pathways to success, roadblocks to progress, and innovative workarounds.

The Qualitative Evaluation Core establishes partnerships with PACT leadership and implementers at the regional, VISN, and facility level to facilitate collaboration and sharing of information. Data collection methods include: site visits to each of the 10 medical centers, observations at training events, interviews with key contacts at medical centers and outpatient clinics at regular intervals, and monitoring of email communications. Data are coded and analyzed using Atlas.ti qualitative data analysis software.

We identified key factors negatively impacting transformation to the PACT model (e.g., resistance to change, inadequate access to accurate and timely data for quality improvement, lack of buy-in from leadership or staff) as well as contributors to success (e.g., willingness to take risks, presence of a local PACT champion, cross-facility sharing of approaches and tools). Some teams responded to barriers at the facility level with quiet workarounds that provided short-term solutions but are not necessarily replicable on a larger scale. A common and important theme arose concerning the dilemma of how individual sites in a somewhat decentralized system can best select and implement processes to meet centralized directives and expectations.

With their knowledge of site-specific conditions and culture, local PACT champions provide critical guidance on how to get things done. When national policymakers delegate responsibility for implementing organizational transformation to ground-level managers and staff and grant latitude in how those changes are enacted, frontline personnel become de facto policymakers.

Taking into account the complexities of how new PACT-related practices are put into place at individual sites is essential to providing context for gauging success of implementation efforts and accurately measuring the impact of changes across VHA.

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