Health Services Research & Development

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Zulman DM, Chang ET, Wong A, Yoon J, Stockdale SE, Ong MK, Rubenstein LV, Asch SM. 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. 2019 May 1; 34(Suppl 1):75-81.
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Abstract: BACKGROUND: Intensive primary care programs aim to coordinate care for patients with medical, behavioral, and social complexity, but little is known about their impact on patient experience when implemented in a medical home. OBJECTIVE: Determine how augmenting the VA's medical home (Patient Aligned Care Team, PACT) with a PACT-Intensive Management (PIM) program influences patient experiences with care coordination, access, provider relationships, and satisfaction. DESIGN: Cross-sectional analysis of patient survey data from a five-site randomized quality improvement study. PARTICIPANTS: Two thousand five hundred sixty-six Veterans with hospitalization risk scores =?90th percentile and recent acute care. INTERVENTION: PIM offered patients intensive care coordination, including home visits, accompaniment to specialists, acute care follow-up, and case management from a team staffed by primary care providers, social workers, psychologists, nurses, and/or other support staff. MAIN MEASURES: Patient-reported experiences with care coordination (e.g., health goal assessment, test and appointment follow-up, Patient Assessment of Chronic Illness Care (PACIC)), access to healthcare services, provider relationships, and satisfaction. KEY RESULTS: Seven hundred fifty-nine PIM and 768 PACT patients responded to the survey (response rate 60%). Patients randomized to PIM were more likely than those in PACT to report that they were asked about their health goals (AOR?=?1.26; P?=?0.046) and that they have a VA provider whom they trust (AOR?=?1.35; P?=?0.005). PIM patients also had higher mean (SD) PACIC scores compared with PACT patients (2.91 (1.31) vs. 2.75 (1.25), respectively; P?=?0.022) and were more likely to report 10 out of 10 on satisfaction with primary care (AOR?=?1.25; P?=?0.048). However, other effects on coordination, access, and satisfaction did not achieve statistical significance. CONCLUSIONS: 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.