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2019 HSR&D/QUERI National Conference Abstract

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4022 — We are not curing a lot of things, but we are caring: GeriPACT patient needs shape team needs

Lead/Presenter: Samantha Solimeo,  COIN - Iowa City
All Authors: Solimeo SL (Center for Access and Delivery Research and Evaluation; Primary Care Analytics Team-Iowa City; Carver College of Medicine, Univ. of Iowa), Steffen, MJ (Center for Access and Delivery Research and Evaluation; Primary Care Analytics Team-Iowa City, Iowa City VA Health Care System), Gardner, EE (Carver College of Medicine, University of Iowa, Iowa City, IA) Adjognon, O (Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System) Shin, MH (Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System) Jennifer Moye, J (New England Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System; Department of Psychiatry, Harvard Medical School) Sullivan, JL (Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System; Boston University School of Public Health, Boston, MA)

Objectives:
This study aimed to enhance the geriatric primary care delivery system evidence base and to support ongoing implementation of geriatric patient aligned care teams (GeriPACTs) by the Office of Geriatrics and Extended Care. Study objectives are to: 1) identify the team-, clinic-, and system-level resources necessary for effective GeriPACT implementation; and 2) differentiate needs of GeriPACT compared to traditional PACT.

Methods:
This study used a qualitive observational design to collect GeriPACT members' perceptions of implementation needs. In-person, audio-recorded, semi-structured interviews were conducted with 80 core team members from 8 geographically dispersed GeriPACTs. Interview transcripts were consensus coded using a codebook which operationalized PACT Resources Framework (True, et al 2013) concepts in terms of the GeriPACT model. Coded data were analyzed iteratively through a series of abstracting, concept mapping, and synthesis with attention paid to site and role. Exemplars for each concept were selected to maximize diversity of roles, sites, and negative examples and reviewed by the analytic team for representativeness and concept fidelity.

Results:
GeriPACTs have resource needs unique to their patient population that may be unrecognized by primary care leadership, including: clinical space to accommodate caregivers and patients with impaired visual, mobility, cognitive, or hearing acuity; greater utilization of caregiver support programs and social workers to facilitate aging-in-place; age-sensitive clinical reminders; team member continuity and direct phone lines to reduce patient anxiety; and longer standard appointment lengths to reflect clinical complexity. GeriPACTs report similar overall concerns with limited clinical space, empanelment, staffing, and matrix reporting structures as PACT, but demonstrate less role clarity and team cohesion challenges than do PACTs. In contrast to PACT, GeriPACT respondents did not emphasize burnout: Respondents noted the stress of providing end-of-life care, but also characterized their work as emotionally rewarding.

Implications:
GeriPACTs face similar general challenges to providing care as traditional PACTs. However, GeriPACTs are not simply "PACTs for older adults": GeriPACT members articulate population-specific resources that require support from facility leadership to accommodate the complex, age- clinical and social resources needed to support aging-in-place. Compared to PACTs, GeriPACT members report strengths such as role clarity, team cohesion, and less burnout.

Impacts:
GeriPACTs' need for team stability and greater use of social work, pharmacy, and mental health providers stem from biopsychosocial and clinical needs of its complex patient population. These analyses demonstrate the importance of recognizing population characteristics in team design. Given that more than 50% of Veterans are 65 and older, GeriPACT strengths should be explored for transferability to PACT.