Lead/Presenter: Jennifer Sulivan, COIN - Bedford/Boston
All Authors: Sullivan JL (CHOIR, Boston University), Shin,MH(CHOIR), Adjognon, O (CHOIR); Steffen, M (CADRE) Moye, J (New England GRECC); Shay, K (Office of GEC, retired) and Solimeo, SL (CADRE)
The Geriatric Patient-Aligned Care Team (GeriPACT) model was implemented in the Veterans Administration (VA) in 2010 to allow providers to focus on issues specifically pertaining to older adults such as functional assessments and caregiver/family involvement. There has been little research specifically focused on implementation of the GeriPACT model to date. This study's objective is to assess factors affecting implementation of GeriPACT in VA using the Consolidated Framework for Implementation Research (CFIR).
We conducted in-person site visits at 8 VA Medical Centers with GeriPACTs. We interviewed 134 key informants (8-12 per site) most knowledgeable of GeriPACT implementation. The 8 sites were highly adherent to the GeriPACT Handbook guidelines, yet varied on level of team functioning and patient-assessed access to primary care. We coded transcripts using direct content analysis, Evidence within each CFIR construct was rated as a positive, mixed (e.g., both positive and negative), or negative influence for each site. We then compared data across the sites and by team functioning and access to primary care to determine factors influencing implementation.
Several common factors positively affected GeriPACT implementation including: knowledge and beliefs, quality and packaging, relative advantage, compatibility, culture, learning climate, and champions/implementation leaders. In addition, relative priority had a negative influence on implementation for a majority of sites. When comparing CFIR constructs by performance in access and team functioning, only one additional factor emerged. Sites with high team functioning had positive networks and communications scores in comparison to low team functioning sites.
The GeriPACT model was successfully implemented partially because the model fit well within the medical center's organizational setting. However, these GeriPACTs also had to compete with other more pressing priorities which hindered implementation. The breadth of factors that positively influenced GeriPACT implementation at these VAMCs underlines the dedication that GeriPACT team members and leaders have for the model and the patient population.
Anticipating potential pitfalls of GeriPACT implementation can improve program sustainability. Focusing on positive network dynamics and communication within the team and across services is a key area where teams can improve model implementation.