3136 — A First Look at PCMH Implementation for Minority Veterans: Room for Improvement.

Hernandez SE, VA Puget Sound Healthcare System; Taylor L, VA Puget Sound Healthcare System; Grembowski D, University of Washington; Reid R, Group Health Cooperative; Wong ES, VA Puget Sound Healthcare System; Nelson KM, VA Puget Sound Healthcare System; Liu CF, VA Puget Sound Healthcare System; Fihn SD, VA Office of Analytics and Business Intelligence; Hebert PL, VA Puget Sound Healthcare System;

Objectives:
Implementation of Patient Aligned Care Teams (PACT), a nationwide patient-centered medical home model of primary care, has not been uniform across the over 900 primary care facilities in the VA. However, there is limited information on the degree to which PACT is reaching minority populations. We sought to determine if the degree of PACT implementation at a facility varied with the percentage of minority patients at the facility.

Methods:
This was a cross-sectional, facility-level analysis of PACT implementation measures in 2012. We excluded facilities with less than an average of 100 patients (n = 2) and having less than 10 respondents to a national patient survey (n = 79), leaving 832 unique facilities for fiscal year 2012 (October 1, 2011-September 30, 2012). Facilities were categorized as low ( < 5.2 percent, n = 209), medium (5.2 percent-25.8 percent, n = 415), and high (greater than 25.8 percent, n = 208) percent minority based on their minority composition. We utilized a previously validated PACT implementation progress index (PI-Squared). PI-Squared consists of eight domains: access, continuity of care, care coordination, comprehensiveness, self-management support, and patient-centered care and communication, shared decision making domains, and team functioning. PI-Squared is a measure of the number of domains in the top quartile minus the number of domains in the bottom quartile.

Results:
Most minority veterans received care in high minority (69 percent) and medium minority facilities (29 percent). In unadjusted analyses 11.3-percent of minority veterans versus 8.3-percent of White veterans received care at low implementation facilities (a PI-Squared score -5 or lower, p < .001); 3.5-percent of minority veterans versus 5.2-percent of White veterans received care at high implementation facilities (PI-Squared score 5 or greater, p < .001). In adjusted analyses, medium and high minority facilities scored 0.726 (p = 0.009) and 0.938 points lower on the PI-Squared score relative to low minority facilities. Both medium and high minority facilities had the same 3 domain scores lower than low minority facilities (care coordination, comprehensiveness, and self-management).

Implications:
Facilities with higher percentages of minority patients were less successful at implementing the patient-centered medical home at VHA.

Impacts:
This is the first study to characterize facility-level PACT implementation in relation to the percent of minority Veterans served. Further research needs to investigate the relationship between the racial composition of a facility and other characteristics that may impede or improve PACT implementation.