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2019 HSR&D/QUERI National Conference Abstract

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4039 — Effects of intensive primary care on high-need patient experiences: Findings from a Veterans Affairs randomized quality improvement trial

Lead/Presenter: Donna Zulman,  COIN - Palo Alto
All Authors: Zulman DM (Center for Innovation to Implementation, VA Palo Alto), Chang E (Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles), Wong A (Center for Innovation to Implementation, VA Palo Alto) Yoon J (Center for Innovation to Implementation, VA Palo Alto) Stockdale S (Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles) Ong M (Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles) Rubenstein L (Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles) Asch SM (Center for Innovation to Implementation, VA Palo Alto)

Objectives:
Intensive primary care programs aim to coordinate care for patients with medical, behavioral, and social complexity, but little is known about their impact on patient experience when implemented in a medical home. We sought to determine how augmenting the VA's medical home (Patient Aligned Care Team, PACT) with a PACT-Intensive Management (PIM) program influences patient experiences with care coordination, access, provider relationships, and satisfaction.

Methods:
The PIM Demonstration Program is a 5-site randomized quality improvement study that is comparing PACT vs. PACT+PIM for Veterans with hospitalization risk scores ? 90th percentile and recent acute care. PIM offers patients intensive care coordination, including home visits, accompaniment to specialists, acute care follow-up, and case management from a team staffed by primary care providers, social workers, psychologists, nurses, and/or other support staff. We conducted a survey of 2,566 Veterans in PIM and PACT to examine whether PIM influenced patient experiences with care coordination (e.g., health goal assessment, test and appointment follow-up, Patient Assessment of Chronic Illness Care (PACIC)), access to health care services, provider relationships, and satisfaction.

Results:
759 PIM and 768 PACT patients responded to the survey (response rate 60%). Patients randomized to PIM were more likely than those in PACT to report that they were asked about their health goals (AOR = 1.26; P = 0.046) and that they have a VA provider whom they trust (AOR = 1.35; P = 0.005). PIM patients also had higher mean (SD) PACIC scores compared with PACT patients (2.91 (1.31) vs. 2.75 (1.25), respectively; P = 0.022) and were more likely to report 10 out of 10 on satisfaction with primary care (AOR = 1.25; P = 0.048). However, other effects on access and satisfaction did not achieve statistical significance.

Implications:
Augmenting PACT with PIM had a positive influence on high-risk patients' experiences with primary care, care coordination, and provider relationships, but did not have a significant impact on other patient-reported access and satisfaction measures.

Impacts:
Future work should investigate the attributes of PIM that can be feasibly implemented in PACT to increase patient trust and improve care coordination and management of chronic conditions and health goals.