Effect of Intensive Primary Care on Patient Experience Outcomes
In response to rising healthcare costs, many healthcare systems are implementing intensive primary care programs for high-need patients with medical, social, and behavioral complexity. These programs typically include proactive care coordination and case management to address medical issues, care fragmentation, care transitions, and other healthcare navigation challenges. To address the gap in evidence about patient experiences with intensive primary care, study investigators conducted a survey (June to December 2016) of Veterans in a five-site randomized trial of intensive primary care in the VA healthcare system. The survey sample was drawn from a list of high-risk Veterans who were randomized to PIM (PACT-Intensive Management; n=759 Veterans) or usual care in PACT (Patient Aligned Care Teams; n=768 Veterans) between August 2014 and December 2015 at the five VA facilities with PIM Demonstration Programs. These PIM programs incorporated features such as regular interdisciplinary team meetings, medication management, home visits, mental health/substance use assessment and support, health coaching, and social work case management. The teams also engaged in activities to coordinate care within VA and across other settings. There were no significant differences between PIM and PACT respondents across sociodemographic or clinical characteristics.
- Augmenting VA's patient-centered medical home with intensive primary care had a modestly positive influence on high-risk patients' experiences with care coordination and provider relationships – but did not have a significant impact on most patient-reported access and satisfaction measures.
- Veterans randomized to PIM were more likely than those in PACT to report that they were asked about their health goals (73% vs. 68%) and about barriers to taking care of their health (60% vs. 55%). Veterans randomized to PIM also were more likely than those in PACT to strongly agree that they could trust their VA healthcare provider (61% vs. 53%) and were more likely to report 10 out of 10 on satisfaction with primary care (37% vs. 32%).
- Findings suggest that augmenting a medical home with an intensive management program may help fulfill the promise of primary care, with the potential for long-term consequences such as changes in health behaviors and clinical outcomes.
- This study was limited to five VA primary care sites that chose to participate in an intensive primary care demonstration program, and three of the five sites had ratings that were at least 5% higher than the national average regarding patient satisfaction.
This study was partly funded by HSR&D. Drs. Zulman, Yoon, Asch and Ms. Wong are part of HSR&D's Center for Innovation to Implementation (Ci2i), Palo Alto, CA; Drs. Chang, Stockdale, Ong, and Rubenstein are part of HSR&D's Center for the Study for Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA.
Zulman D, Chang E, Wong A, Yoon J, Stockdale S, Ong M, Rubenstein L, Asch S. Effects of Intensive Primary Care on High-Need Patient Experiences: Survey Findings from a Veterans Affairs Randomized Quality Improvement Trial. Journal of General Internal Medicine. May 2019;34(Suppl 1):75-81.