Lead/Presenter: Sylvia Hysong,
COIN - Houston
All Authors: Hysong SJ (Houston COIN), Amspoker, A. B. (Houston COIN), Hughes, A. M. (Biomedical and Health Information Sciences, University of Illinois at Chicago) Lester, H. F. (Houston COIN) Svojse, E. K. (Houston COIN) Brown, C. (Houston COIN) Knox, M. (Houston COIN) Petersen, L. A. (Houston COIN)
To assess the effectiveness of an intervention composed of training, audit and feedback, and team debriefing to improve coordination (outcomes) in Patient Aligned Care Teams (PACTs).
We conducted a 7-month case-control trial comparing 34 PACTs (57 individuals) from four facilities in two regional VA networks to 34 matched control PACTs. Our audit-and-feedback intervention consisted of monthly reports about key coordination behaviors with structured PACT debriefings. Outcomes included appointments starting on time, timely recall scheduling, emergency room utilization, My HealtheVet utilization, patient education, clinical reminders, patient satisfaction and overall coordination. Multilevel models were utilized to assess the effects of the intervention and the average number of PACTs to which a group's team members were assigned (PACT-level degree) on coordination over time. Intervention exposure was operationalized as follows: total exposure, (number of debriefings at least 1 PACT member attended); rate of exposure (percentage of debriefings at least 1 PACT member attended); and strength of exposure (average percent of PACT members attending debriefings per month).
Compared to controls, treatment-arm PACTs did not exhibit significantly greater improvements in coordination outcomes. However, in follow-up analyses among intervention PACTs we found improvements in: overall coordination for PACTs with higher rates of exposure (b = 0.01, p = 0.002); clinical reminder completion (b = 0.70, p < 0.0001) among PACTs with higher total exposure relative to PACTs with lower total exposure. High total exposure PACTs also avoided increases in ER utilization over time (i.e., b = -0.01, p = 0.89).
Audit and feedback can improve coordination in primary-care PACTs if attention is paid to total and rate of exposure to feedback instead of the strength of exposure. Specifically, it is more important for debriefs to occur consistently than for the entire PACT to attend a given debrief.
Audit and feedback can be a budget-friendly tool for improving coordination. Further, our work uncovers opportunities for more targeted implementation of PACT-based interventions: By strategically exposing PACT members to the intervention, the time burden of research participation can be distributed across PACT members, thereby potentially reducing cost, participant fatigue, and impact to patient care.