Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1079 — Promoting Veteran and Employee Engagement in Diabetes Management through the Transformational Elements of the PACT Model

Lead/Presenter: LeChauncy Woodard, COIN - Houston
All Authors: Brown C (Houston Center for Innovations in Quality, Effectiveness and Safety (IQuESt) at Michael E. DeBakey VA Medical Center) Kiefer L (Houston Center for Innovations in Quality, Effectiveness and Safety (IQuESt) at Michael E. DeBakey VA Medical Center & Baylor College of Medicine) Naik AD (Houston Center for Innovations in Quality, Effectiveness and Safety (IQuESt) at Michael E. DeBakey VA Medical Center & Baylor College of Medicine) Hundt N (Houston Center for Innovations in Quality, Effectiveness and Safety (IQuESt) at Michael E. DeBakey VA Medical Center & Baylor College of Medicine) Jones L (Houston Center for Innovations in Quality, Effectiveness and Safety (IQuESt) at Michael E. DeBakey VA Medical Center) Woodard LD (Houston Center for Innovations in Quality, Effectiveness and Safety (IQuESt) at Michael E. DeBakey VA Medical Center & Baylor College of Medicine)

Objectives:
The VA's Patient Aligned Care Team (PACT) model is uniquely suited to address complex chronic diabetes care management, where self-management skills are critical. Providing effective self-management training and support can be challenging due to time constraints and limited clinician training with behavior change. We sought to build an interprofessional diabetes management intervention and understand how it improves the Veteran and employee experience of chronic care management by optimizing the PACT model.

Methods:
We conducted a hybrid implementation-effectiveness study of a self-management intervention, Empowering Patients in Chronic Care (EPIC). We implemented the EPIC intervention into routine primary care workflows using interprofessional teams of 2-4 diabetes care clinicians (e.g. pharmacists, dietitians, psychologists) who were trained to deliver six group-visit sessions with 5-8 Veterans. Sessions adopted a shared-decision making approach to address collaborative goal setting, self-management action planning, and communication. We used exit interviews to collect qualitative data from Veterans and cross-facility calls between clinicians to collect data on the clinician experience. We conducted a summative evaluation, using key-informant interviews, to evaluate clinician engagement and implementation success.

Results:
Veteran response has been generally positive. Veterans enjoyed the group-visits ("The open discussion... helped everyone open up. It opened up your eyes more to a lot of ideas and opportunities."), the patient-centered personalization ("I had permission to be a 'real' person"), and the skill-building opportunities ("I learned to take care of myself"). Clinicians specifically enjoyed the interaction EPIC facilitated between the interprofessional team. Clinicians noted that delivering EPIC fostered satisfying professional collaborations. They also endorsed the culture change that the intervention evinced, offering "we need buy-in for the culture change to shared-decision-making from patients and providers," and the intervention "touches a larger shift in healthcare--having EPIC available is good for those who are [ready to embrace shared-decision-making]".

Implications:
Clinicians need specific opportunities to experience and develop expertise with the transformational elements of the PACT model, i.e. shared-decision-making, patient-centered, interprofessional care. The EPIC intervention enhanced engagement among PACT clinicians because it integrated these transformational elements.

Impacts:
Patient-centered, interprofessional research interventions are incubators of culture change toward the PACT model for primary care delivery.