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2019 HSR&D/QUERI National Conference Abstract

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1128 — High-Risk Patients' Experiences of Engagement in VA's Patient-Aligned Care Team (PACT) Intensive Management (PIM) Program

Lead/Presenter: Alicia Bergman,  COIN - Los Angeles
All Authors: Bergman AA (Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles), Stockdale S (Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles), Katz M (Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles) Zulman D (Center for Innovation to Implementation, VA Palo Alto Health Care System) Evelyn Chang (Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles)

Objectives:
Many healthcare systems are seeking ways to improve care for complex high-risk patients, but engaging these patients can be challenging due to medical, social, and behavioral barriers to patients' participation in their healthcare. The Veterans Health Administration (VA) piloted intensive primary care programs, called PACT Intensive Management (PIM), to improve services for high-risk Veterans in primary care, in part by addressing engagement barriers. Our goal was to assess how patients experienced engagement through qualitative patient interviews.

Methods:
Methods: We conducted semi-structured telephone interviews with 51 patients who had at least four encounters with the PIM team. Interviews were recorded, transcribed, and analyzed to identify major themes around patient engagement with their own healthcare and the VA.

Results:
Patients highlighted how participating in PIM facilitated improved engagement with their own healthcare. Our analysis revealed two types of patient engagement experiences: 1) those that were dependent upon enabling engagement strategies of PIM providers/teams, and 2) self-care activities that were initially facilitated by PIM provider/team actions, but subsequently performed by patients. Examples of the former included ability to see or communicate with PIM PC providers directly without an appointment, PIM providers facilitating improved access to specialists, PIM providers/team proactively making follow-up/check-in phone calls to patients in between appointments and reminding them about upcoming appointments, and giving PIM providers/team giving clear descriptions for how and why to take medications or the necessity of certain medical procedures. Examples of the latter included positive changes in general/daily self-care based on PIM teams providing education, such as checking blood sugar daily based on increased understanding of diabetes, adhering to medication regimens, and sustaining an improved diet by looking for hidden sodium in canned foods.

Implications:
Patients discussed two forms of engagement experiences that arose from PIM: those that were entirely due to PIM team actions, and those centered on self-care activities that were initiated by the PIM team but later internalized by the patient.

Impacts:
A more detailed understanding of how high-need patients experience engagement and what provider/team engagement enablers they perceive as most important may inform intervention design for intensive primary care programs and other services.