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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4074 — A Simulation Study of the Long-Run Implications for Veterans' Cardiovascular Outcomes and Costs after Wide-Spread Implementation of the VA Patient-Centered Medical Home Model

Lead/Presenter: Paul Hebert, COIN - Seattle/Denver
All Authors: Hebert PL (Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA) Simonetti J (VA Denver Medical Center) Coxson P (Center for Vulnerable Populations, University of California, San Francisco) Batten A (Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA) Liu CF (Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA)

In 2010, the VHA launched the PACT initiative to implement a patient-centered medical home model at all primary care clinics. Recently, the PACT Implementation Progress Index (PI2), a clinic-level measure of the extent to which a clinic meets eight core domains of patient-centered care, showed that clinics in the highest decile of PI2 had significantly better management of systolic blood pressure (SBP), low-density lipoprotein (LDL) cholesterol, and HbA1c levels compared to clinics in the lowest decile. This study addressed the long-run implication for mortality, morbidity and healthcare use and costs for Veterans if all VHA clinics performed as well as Veterans in clinics with the highest PI2 scores.

We conducted a simulation study using a customized version of the Coronary Heart Disease Policy Model (CHDPM) and a simulated population of Veterans age 35+ from 2016-2034. We customized the CHDPM to the current cardiovascular-risk profiles and event rates of VHA patients, and incorporated expected growth in the population of VHA patients by age and gender. We developed CHDPM inputs by estimating how SBP, LDL, and HbA1c levels would change if Veterans at every VHA facility performed as well on these measures as did Veterans at facilities in the top PI2 decile. We then simulated the effects of these changes on health outcomes and costs.

If all VHA facilities performed as did those among the highest PI2 decile, we would see reductions in Veterans' SBP by 2.0 mm Hg; LDL cholesterol by 3.6 mg/dL; and, for diabetic Veterans, HbA1c by 0.01 percentage points. If sustained from 2016-2034, these changes would result in 21,000 fewer cases of incident heart disease, 10,500 fewer new and recurrent myocardial infarctions, 7,300 fewer strokes, 5,700 fewer deaths from any cause, and $2.1 billion lower CHD- and stroke-related costs.

Greater clinic-level PACT implementation is associated with higher quality care. If this level of clinical quality could be achieved by all VHA clinics and sustained from 2016-34, modest yet meaningful reductions in cardiovascular events and associated costs could be expected.

The VHA should consider the potential long-run implications of the improved clinical quality of care associated with better PACT implementation.