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2019 HSR&D/QUERI National Conference Abstract

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4075 — Geriatric Patient-Aligned Care Team Members' Perceptions of the Unique Functions and Challenges of a "One Stop Shopping" Model for Geriatric Care

Lead/Presenter: Marlena Shin,  COIN - Bedford/Boston
All Authors: Shin MH (Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System), Solimeo SL (Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Primary Care Analytics Team-Iowa City, Iowa City VA Health Care System, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA), , Adjognon O (Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System), Moye J (New England Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System), Harvey K (Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System), Sullivan JL (Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston University School of Public Health, Boston, MA)

Objectives:
The VA's Geriatric Patient-Aligned Care Teams (GeriPACT) provide age-sensitive primary care (PC) to older Veterans that aligns with VA's learning healthcare system goals through comprehensive, coordinated, and patient-centered care. While literature highlights GeriPACT's strengths, little is known about how team members perceive the strengths or challenges of providing GeriPACT care. Our paper evaluates GeriPACT members' perceptions about: 1) the model's unique functions (i.e., strengths); and 2) the barriers to providing care.

Methods:
By administering a web-based survey to 627 GeriPACT members across 71 VAMCs, we asked two open-ended response items about: 1) the unique function that GeriPACT provides that is not provided by other services and 2) the barriers to providing care in their GeriPACT. We conducted a content analysis using a matrix approach to group and order responses into categories (most to least often reported), synthesized responses within each category to identify emergent themes, and created a summary document of themes with representative quotes.

Results:
Respondents ranged from MDs, RNs to dieticians, psychologists, social workers, health administrators (52% response rate). Respondents most often reported that GeriPACT is unique because it focuses on geriatric patient needs and provides specialized care that differs from a typical PC visit. Respondents also perceived GeriPACTs as providing comprehensive continuity of care by a cohesive team as well as better access to care (e.g., longer appointment times compared to standard PC). Allowing for close involvement with other disciplines and offering patients with providers trained/certified in geriatrics also were reported as unique functions. Major barriers included staff shortage, inadequate clinic space, and lack of team communication/coordination at times. Despite having longer appointments compared to standard PC, respondents reported the need for even more time with patients during appointments given their needs.

Implications:
Our findings contribute important information from the perspectives of GeriPACT members which further confirm the model's strengths and identify several key barriers/challenges.

Impacts:
Given the growth in an aging Veteran population, identifying ways to resolve the barriers faced by GeriPACT team members are important next steps to further strengthen the learning healthcare system for providing comprehensive, coordinated, and patient-centered PC to older adults.