Impact of PACT Implementation on Primary Care Delivery Patterns

Lampman MA, Rosenthal GE, Vaughan-Sarrazin MS. Impact of PACT Implementation on Primary Care Delivery Patterns. Poster session presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 17; National Harbor, MD.

Objectives: The Patient-Aligned Care Team (PACT) model fosters team-based care and diffusion of patient care responsibilities to individual team members. This study compared patterns of primary care (PC) delivery before and after PACT implementation and examined if patterns differed among teams that did and did not participate in PACT Learning Collaboratives (LC). Methods: The Primary Care Management Module was used to identify 304,339 VISN 23 patients with PC visits in the first 6 months of FY 2009 (pre-PACT) and FY 2011 (post-PACT). PC encounters were summarized by provider type and service intensity using the VA Outpatient Care Files. Patterns of service were compared in patients receiving care from 30 VISN 23 teams participating in PACT LCs and from other PC teams. Analyses controlled for patient demographics and comorbidity, and clustering of patients within PC teams. Results: Overall, 24,981 (8.2%) of patients were assigned to LC providers. The risk-adjusted mean number of total PC encounters per patient increased to a relatively similar degree in LC teams (8%, from 1.99 to 2.15) and non-LC teams (10%; from 1.94 to 2.14). In analyses by PC team member, mean provider (MD, physician assistant, or nurse practitioner) visits increased somewhat less (6%, 1.43 to 1.51) for LC patients than non-LC patients (10%, 1.40 to 1.54), while mean RN care manager visits increased somewhat more (36%, 0.47 to 0.64) for LC patients than non-LC patients (25%, 0.44 to 0.55). Consistent with this trend, the percent of provider visits that involved Level 4 or 5 Evaluation and Management CPT codes increased by 5% (44% to 49%) for LC patients, compared to 2% for non-LC patients (43% to 45%). Implications: PACT implementation was associated with a modest increase in PC encounters. The relative increases in visits were greater for RN care managers than providers. Changes in patterns of visits were somewhat greater for teams that participated in LCs. Impacts: Early analyses suggest that PACT implementation may be associated with higher levels of team-based PC and with providers practicing to their maximal level of training. These changes may be facilitated by LCs. Future research is needed to determine the impact of these changes in PC delivery on patient outcomes.