JGIM Supplement Highlights VA's Patient-Aligned Care Teams
In 2010, VA launched a national implementation of patient-centered medical homes (PCMH) through the Patient Aligned Care Teams (PACT) initiative, including a national rollout to all VA primary care practices in more than 150 medical centers and over 800 community-based outpatient clinics. Funded by VA's Office of Patient Care Services' Primary Care Program Office, this JGIM Supplement includes 19 articles that share lessons learned by researchers and their clinical and policy partners during the early stages of PACT implementation. Articles focus on its roll-out, as well as its evaluation. The PACT initiative incorporates rigorous evaluation through five PACT Demonstration Laboratories, led by HSR&D investigators. Together, the implementation and evaluation components of PACT document opportunities and challenges in implementing a PCMH in integrated healthcare systems that are both specifically relevant to VA and informative to other managed healthcare organizations engaged in implementing PCMH models. In addition, the articles have implementation science implications, as they address components of the Chronic Illness Care Model. Following is a brief summary of findings.
- Katz and colleagues examined the relationships between continuity—a high-value PACT attribute—and patient-provider communication. In this study, decreased primary care provider continuity was associated with significantly lower perceived quality of patient-provider communication. Werner and colleagues, in turn, examined the relationship between access and emergency room (ER) use. Using national VA data, they found that the absence of a primary care provider for a week or more had a small but statistically significant relationship to increased ER visits, especially if that provider was the sole or near-sole provider of a patient's care. Combined, these findings support the importance of both continuity and access, and the need to reduce current variations in these key PACT features.
- Luck and colleagues evaluated a national online repository of tools created to facilitate PACT implementation. More than 6,000 staff used the repository in the first 19 months of its availability.
- O'Neill and colleagues report on a comparison of primary care physician vs. clinical pharmacist-directed nurse case management of PACT patients with poorly controlled hypertension. Their findings suggest that clinical pharmacists can supervise multiple nurse care managers in titrating medications for patients with poorly controlled hypertension, thus potentially reducing bottlenecks related to physician access by the nurses and increasing nurse care management capacity.
- Fix and colleagues describe wide variations in the delivery of PACT-principled care in VA HIV specialty care clinics, and found that patients were less satisfied with care in HIV clinics that had features that were less PACT-aligned. Yano and colleagues raise similar implications for PACT around delivering gender-sensitive comprehensive care to female Veterans, who may be seen in separate women's health clinics or in general primary care clinics with varying levels of readiness for handling women's primary care needs.
Journal of General Internal Medicine (JGIM) Supplement. July 2014;29(2 Suppl):547-707.