Study Examines Changes in Care Processes and Patient Outcomes Related to VA's Implementation of PACT Model
In 2010, VA began implementing the patient-aligned care team model (PACT) in all primary care clinics nationwide – implementation will continue through 2014. The PACT model focuses on transforming primary care in three areas: practice re-design, access to care, and care management and coordination. This study examined whether changes in VA healthcare delivery under the PACT transformation led to changes in organizational processes of care and patient outcomes. Investigators identified 683 primary care providers (PCPs) at 10 VAMCs in VISN 4, who provided care to 321,295 Veterans between July 2010 and June 2012. Using detailed interview data on PACT implementation, including the uptake of 10 measures of structural changes to support PACT implementation (i.e., care management of high-risk patients, nurse medication protocols, transitions from the hospital, team communication and functioning), and clinical encounter data, investigators examined the effect of PACT implementation on four outcome variables: three organizational processes (telephone-based primary care visits, appointment within three days of desired appointment date, and contact within two days of discharge from hospital), and one patient outcome (emergency department visits).
- Medical home implementation in the VA healthcare system resulted in large changes in the structure of care, but few changes in patient-level organizational processes or outcomes.
- There were significant improvements in two-day post-hospital discharge contact, but not primary care visits occurring by telephone or within three days of the requested date.
- There was no association between medical home implementation and rates of emergency department use by Veterans.
- Over the study period, the percentage of PCPs who were part of the PACT model more than tripled, and the percentage of PCPs that implemented elements of the PACT model increased significantly.
- This is an observational study, thus the associations between medical home implementation and changes in processes and outcomes that were found are just that – associations.
- VA's implementation of the PACT model of care is a work in progress; therefore, any changes in care may be the result of a necessary learning process. Also, this study focused on a limited set of outcomes, most of which were organizational processes and not patient outcomes.
Drs. Werner and True are part of HSR&D's Center for Health Equity Research & Promotion in Philadelphia. Dr. Werner also is Director of the VISN 4 PACT Demonstration Lab.
Werner R, Canamucio A, Shea J, and True G. The Medical Home Transformation in the Veterans Health Administration: An Evaluation of Early Changes in Primary Care Delivery. Health Services Research January 30, 2014; e-pub ahead of print.