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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1036 — Perceived Barriers to Improving Advanced Clinic Access When Implementing Patient Aligned Care Teams (PACT)

Solimeo SLLampman MOno SSPaez MBReishus JCarroll N, and Stewart G, VISN 23 PACT Demonstration Lab and Center for Comprehensive Access Delivery & Research (CADRE), Iowa City VA Healthcare System;

To identify perceived barriers to enacting Advanced Clinic Access among 22 teams implementing PACT in VISN 23.

Audio-recorded, semi-structured, 1:1 telephone interviews (n = 53) and site visits (n = 6) were conducted with VISN 23 PACT Collaborative participants. PACT team monthly reports were collected over a period of 18 months. All data were topically and thematically coded using consensus coding and MAXQDA software. Coding patterns were compared across site type (VAMC, CBOC) and role (Provider, RN, LPN, Clerical Associates) to identify salient barriers to Advanced Clinic Access (ACA).

Teams employed a number of strategies to improve access, including: appointment pre-calling; schedule scrubbing; RN appointments; post-discharge telephone contact; and MyHealtheVet. Perceived barriers to improving access clustered around data management, staffing, and professional identity. Participants reported that provider-level data are difficult to obtain, and reported data generally lags current team practices. Access gains made by PACT Collaborative teams who do not have sole control over their schedules were short-lived, as other providers’ patients were scheduled into their clinics, eroding enthusiasm for continuing ACA. Staffing shortages, particularly for providers and Clerical Associates, were viewed as undermining the gains made by same day access and appointment pre-calls. Provider shortages and leave time decrease access. Understaffed clerical roles make completing pre-calling work difficult. Beliefs about professional identity also limit the amount of delegation across roles within teams, which is required to facilitate several access strategies.

Despite focused training and informational support from a learning collaborative, site-level leadership and infrastructural factors constitute barriers for teams striving to improve access. ACA within PACT requires site-level leadership that invests in panel management through adequate staffing, protected schedules, and infrastructural resources.

Access is a fundamental component of patient satisfaction, a PACT pillar, and often the focus of a team’s first aim for improvement. Successful strategies to improve access are dependent upon good team communication, team access to and understanding of provider level data, adequate clinic staffing, enhanced RN clinics, schedule scrubbing, and appointment pre-calling.

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