Lead/Presenter: Susan Stockdale, COIN - Los Angeles
All Authors: Stockdale SE (Center for the Study of Healthcare Innovation, Implementation, and Policy), Katz ML (Center for the Study of Healthcare Innovation, Implementation, and Policy), Bergman AA (Center for the Study of Healthcare Innovation, Implementation, and Policy) Zulman D (Center for Innovation to Implementation) Denietolis A (VHA Office of Primary Care Services) Chang ET (Center for the Study of Healthcare Innovation, Implementation, and Policy)
Some research, including a recent 5-site demonstration within VHA, shows that intensive primary care (IPC) programs for complex patients may not generate cost savings. Using existing PACTs to better manage complex patients in primary care through enhanced resources and training may be a less costly alternative. Our objective was to identify which IPC components key stakeholders thought could be incorporated into PACT workflow, and additional resources, trainings, and staff needed to better manage complex patients in primary care.
We interviewed 44 primary care leaders, providers, nurses, social workers, and IPC program leaders at 5 VHA IPC sites, asking which components of IPC the PACTs could feasibly perform and what resources, trainings, or staffing they would need. We conducted analysis of a priori themes using a rapid qualitative analysis approach.
Most interviewees thought that PACTs could perform clinic-based aspects of IPC, including more frequent calls/visits with patients, patient/caregiver education, psychosocial support, referrals to community services, and managing care transitions. Home visits and co-attending appointments requiring physical absence from clinic were perceived as key IPC components but less feasible. Use of existing home visit services buttressed with better collaboration between PACTs and these services may be more feasible than PACTs conducting home visits. Interviewees said that PACTs would need full staffing (including behavioral health, pharmacy, and other ancillary services) and more dedicated time for chart reviews, assessments, interdisciplinary team meetings, and patient follow-up. Some thought that additional staffing, especially RN care managers and social workers, or smaller panels would be needed. Most thought PACTs could use existing care management tools and resources, but would need more training in identifying and using them, and more training in social determinants of health and patient engagement/goal setting.
PACTs may be able to adopt certain IPC practices for complex patients, such as more frequent contact, psychosocial support, and intensive management of care transitions, but are less suited for services such as home visits and co-attending appointments.
PACTs need full staffing, enhanced collaboration with existing home care services, and training in use of existing tools and resources to optimally manage complex patients in primary care.