Challenges Facing Primary Care Practices Aiming to Implement Patient-Centered Medical Homes

Farmer, Melissa M.; Rose, Danielle E.; Rubenstein, Lisa V.; Canelo, Ismelda; Schectman, Gordon; Stark, Richard; Yano, Elizabeth M.

doi:10.1007/s11606-013-2691-y

Cited by 20 publications

(14 citation statements)

References 32 publications

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“…For Years 2 and 3, we will re-administer the same surveys, adapting selected domains in relation to EBQI targets of participating VAs. We will include measures of leadership support (22), local resources (e.g., sufficiency of time, personnel, equipment) (23), practice structure (e.g., women's health care model, staff mix, referral arrangements), service availability (24), care coordination arrangements (within and outside VA), ability to engage in QI (e.g., barriers to QI, data access by gender), gender-sensitivity of environment (e.g., privacy), local challenges (e.g., provider shortages, hiring difficulties, practice chaos) (25,26), facility type (e.g., size, academic affiliation, urban/rural), and EBQI activities (17). We will field surveys through REDCap, a VA-approved web survey vendor.…”

Section: Data Sources and Measuresmentioning

confidence: 99%

Dynamic waitlisted design for evaluating a randomized trial of evidence-based quality improvement of comprehensive women’s health care implementation in low performing VA facilities

Hamilton

Olmos-Ochoa²,

Canelo³

et al. 2020

Preprint

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Abstract Background : Women’s Health Services (WHS) in the Veterans Health Administration (VA) has long partnered with VA researchers to evaluate how VA care is organized for women Veterans. This partnership has yielded substantial evidence of 1) variations in women Veterans’ access to comprehensive healthcare services that contribute to disparities in quality and patient experience, and 2) the positive impacts of gender-specific care models for women Veterans’ quality and satisfaction. In an effort to provide support specifically to sites that were low-performing in women’s health, WHS and the VA Quality Enhancement Research Initiative co-funded an effort to roll out and evaluate evidence-based quality improvement (EBQI), an implementation strategy with demonstrated effectiveness in a prior cluster randomized trial in women’s health clinics. Methods : We will identify 21 low-performing VA facilities through a combination of WATCH data, VA quality metrics (by gender) and other indicators. In partnership with WHS, an EBQI contractor will deliver the EBQI “package” – local consensus-development and priority-setting using stakeholder panels, multilevel stakeholder engagement, practice facilitation, local EBQI team training, and formative feedback – to participating sites. We propose a dynamic wait-listed design to evaluate the WHS plans for seven EBQI launches per year over three years. The goal is to evaluate: (1) barriers and facilitators to achieving delivery of comprehensive women’s health care in low-performing VA facilities; (2) effectiveness of EBQI in supporting low-performing VA facilities achieve improved practice features (e.g., level of comprehensive services available, care coordination arrangements, Patient Aligned Care Team (PACT) features implemented, environment of care improvements), provider/staff attitudes (e.g., improved gender awareness, women’s health knowledge and practice), quality of care, and patient experience; and (3) contextual factors, local implementation processes, and organizational changes over time. Discussion : Access to comprehensive women’s health care reduces fragmentation of care, improves patient satisfaction and results in better patient outcomes. We hypothesize that EBQI implementation will result in changes in leadership awareness and buy-in, multilevel engagement in problem-solving, an enhanced culture of quality improvement, structural changes in care, improved provider/staff attitudes, and better quality and patient experience.

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Section: Data Sources and Measuresmentioning

confidence: 99%

Dynamic waitlisted design for evaluating a randomized trial of evidence-based quality improvement of comprehensive women’s health care implementation in low performing VA facilities

Hamilton

Olmos-Ochoa²,

Canelo³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Despite implementing a cohesive, collaborative team dedicated to geriatrics, Bronze GeriPACT shares challenges reflective of national variation in PACT and GeriPACT implementation. 12,13…”

Section: Geripact Implementation At the Atlanta Va Medical Centermentioning

confidence: 99%

Implementation of the Geriatric Patient-Aligned Care Team Model in the Veterans Health Administration (VA)

et al. 2018

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“…During the beginning stages of strategic planning for implementing VA's PACT, top challenges faced by primary care directors were reviewed and included clinical informatics, chronic pain management, and care coordination [54]. In the early stages of implementation, several challenges were identified to move to the team-based approach including: (1) short-staffing undermined development of team-based working relationships; (2) lack of co-location of PACT members in clinic and difficulty communicating with residents when they were off-site hampered communication and; (3) limited clinic hours of part-time primary care providers and residents prevented clinicians to get the training and reinforcement of PCMH principles which delayed the team formation [55].…”

Section: Pcmh Scope and Implementation Strategiesmentioning

confidence: 99%

The Veterans Affairs Patient Aligned Care Team (VA PACT), a New Benchmark for Patient-Centered Medical Home Models: A Review and Discussion

Bidassie¹

2017

Patient Centered Medicine

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Challenges Facing Primary Care Practices Aiming to Implement Patient-Centered Medical Homes

Cited by 20 publications

References 32 publications

Dynamic waitlisted design for evaluating a randomized trial of evidence-based quality improvement of comprehensive women’s health care implementation in low performing VA facilities

Dynamic waitlisted design for evaluating a randomized trial of evidence-based quality improvement of comprehensive women’s health care implementation in low performing VA facilities

Implementation of the Geriatric Patient-Aligned Care Team Model in the Veterans Health Administration (VA)

The Veterans Affairs Patient Aligned Care Team (VA PACT), a New Benchmark for Patient-Centered Medical Home Models: A Review and Discussion

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