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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3146 — Developing a Toolkit to Enhance PACT: Improving Hypertension and Smoking Outcomes through Panel Management Assistants

Savarimuthu SMBennett KJFox JRPekala KALeung JDembitzer ADSherman SEGillespie CGAxtmayer A, and Schwartz MD, VA New York Harbor Healthcare System

Coincident with the nation-wide implementation of PACT (Patient Aligned Care Teams), we are implementing a study of the incremental impact of panel management and clinical microsystem education on hypertension and smoking outcomes. PROVE (Program for Research on Outcomes of VA Education) will study the effectiveness of adding a panel management assistant (PMA) to the PACT teams. We sought to define a toolkit of core strategies that non-clinician PMAs will use to enhance panel-wide outcomes in smoking cessation and hypertension.

Researchers conducted semi-structured interviews with 12 primary care providers and 5 administrators and staff to determine and resolve care gaps amenable to PMA intervention. Interviews with core PACT team members led to identification of additional key informants using snowball sampling techniques. These multidisciplinary interviews included clinical directors, health behavior coordinators, and smoking cessation and hypertension experts. Using meeting notes, PMA strategies were organized by care gap targeted, and grouped together into specific domains.

An exemplar strategy toolkit was brainstormed that identified 10 PMA strategies addressing 9 care gaps. These were grouped into 5 domains – access to care, patient centeredness, patient education, and hypertension- and smoking cessation-specific strategies. Toolkit examples include: 1) Domain: Access to care; Gap: Increasing outreach to vulnerable patients; Strategy: Perform database queries and follow-up for uncontrolled hypertensive patients not seen in 1 year. 2) Domain: Patient education; Gap: Addressing self-monitoring of blood pressure; Strategy: Distribute blood pressure monitors to patients at a group educational session. 3) Domain: Smoking cessation-specific strategies; Gap: Addressing barriers to quitting; Strategy: Follow-up phone call two weeks after patient prescription of nicotine replacement.

The panel management model will be tested in a quasi-experimental trial at the VA NY Harbor Healthcare System. The identified care gaps and toolkit will shape the assistance that PMAs will provide PACT teams assigned a PMA. This, in turn, will serve a critical role in generating an atmosphere of patient-centered care.

Although panel management is a central aspect of PACT, there is little guidance or evidence as to how PACT teams should accomplish this role. Piloting the PMA position can provide valuable insight into PACT effectiveness and thus improve the overall quality of patient care within the VA.

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