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Zulman DM. Intensive Management for High-Risk Patients. Briefings for VA leadership in Patient Care Services, HSR&D, Mental Health Operations, and Women’s Health Services. 2015 Apr 16.
To advance VHA's Blueprint for Excellence imperative to "improve the quality of care for Veterans with complex medical conditions through an evolving approach to personalized, proactive and patient-centered care," VHA commissioned one VA facility in FY2012 and five VA facilities in FY2013 to implement an intensive management program for high-risk patients in Patient Aligned Care Teams (PACT). In addition, VHA required an evaluation of these intensive management programs. VHA operations sponsors specified key parameters that framed how these partnership projects were designed and implemented. These parameters included: 1) rapid implementation and evaluation of a PACT population-based approach to intensive management; 2) a quality improvement (QI) design; 3) rigorous evaluation based on outcomes for patients randomly identified as intensive management patients; and 4) evaluation of diverse intensive management approaches using common measures of economic and clinical impact. Within VHA, this type of partnered research provides an approach for iteratively improving and evaluating innovative pilot programs, an opportunity to study and refine innovative pilot programs, thereby maximizing their potential for successful scale-up and spread. The workshop presenters represent operations, implementation and evaluation perspectives in highlighting the projects' early impacts and lessons learned. This briefing identifies potential approaches to 1) improving outcomes among Veterans at high risk of hospitalization or emergency department use and 2) rigorously evaluating intensive management programs. Presents brief overviews of key aspects of the projects. Questions considered: "What are the potential strengths and limitations of the six different approaches to improving outcomes through intensive management programs? What are the practical and ethical dilemmas in combining rigorous evaluation with rapid QI implementation?" Target Audience: Researchers, VA leaders, policymakers.
