Medical Home Features of VHA Primary Care Clinics and Avoidable Hospitalizations

Yoon, Jean; Rose, Danielle E.; Canelo, Ismelda; Upadhyay, Anjali; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V.; Yano, Elizabeth M.

doi:10.1007/s11606-013-2405-5

Cited by 31 publications

(22 citation statements)

References 18 publications

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“…Despite important differences in study design and setting, we note that studies of medical home implementation within the Veterans Health Administration (VHA) also have found associations with quality and utilization of care. 24,25 Like the practices participating in the northeast PACCI, VHA primary care practices had access to data on their patients’ utilization of hospital and ED services, potentially enhancing their abilities to function effectively as medical homes.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care

Rosenthal²,

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care

Rosenthal²,

et al. 2015

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“…4 Medical home features, such as enhanced patient access, improved scheduling, care provider continuity, and care coordination activities, have been associated with lower rates of avoidable hospitalizations and decreased Emergency Department use. [5][6][7][8] Multiple difficulties in implementing the PCMH model, however, have been documented. The move away from a physician-centric model of care towards one that is truly team-oriented, and the challenges of aligning financial reimbursement with the PCMH's emphasis on proactive prevention, are only two of the model's persistent challenges across diverse primary care practices.…”

Section: Introductionmentioning

confidence: 99%

“We’ve Not Gotten Even Close to What We Want to Do”: a Qualitative Study of Early Patient-Centered Medical Home Implementation

et al. 2014

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BACKGROUND:The Veterans Health Administration (VA) Patient Aligned Care Team (PACT) initiative is designed to deliver a medical home model of care associated with better patient outcomes, but success will depend in part on the model's acceptability and sustainability among clinic employees. OBJECTIVE: We sought to identify key themes in the experience of primary care providers, nurse care managers, clerical and clinical associates, and clinic administrators implementing PACT, with the aim of informing recommendations for continued development of the model and its components. DESIGN: Observational qualitative study; data collection from 2010 to 2013, using role-stratified and team focus groups and semi-structured interviews. PARTICIPANTS: 241 of 337 (72 %) identified primary care clinic employees in PACT team or administrative roles, from 15 VA clinics in Oregon and Washington. APPROACH: Data coded and analyzed using conventional content analysis techniques. KEY RESULTS: Overall, participants were enthusiastic about the PACT concept, but felt necessary resources for success were not yet in place. Well-functioning teams were perceived as key to successful implementation. Development of such teams depended on adequate staffing, training, and dedicated time for team development. Changes within the broader VA system were also seen as necessary, including devolving greater control to the clinic level and improving system alignment with the PACT model. PACT advocates from among clinic and institutional level leadership were identified as a final key ingredient for success. These themes were consistent despite differences in clinic settings and characteristics. CONCLUSIONS: PACT implementation faced significant challenges in its early years. Realizing PACT's transformative potential will require acting on the needs identified by clinic workers in this study: ensuring adequate staffing in all team roles, devoting resources to in-depth training for all employees in communication and other skills needed to maximize team success, and aligning the broader VA hospital system with PACT's decentralized, team-based approach.KEY WORDS: primary care redesign; patient-centered medical home; team-based care; Veterans; health services research; qualitative research.

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“…With mounting evidence that primary care clinics that deliver team-based care manage chronic diseases more effectively and lower risk of avoidable hospitalizations, it is critical that PACT members are, in fact, able to create effective teams to provide coordinated care and accommodate team member transitions. [13][14][15] Insights relevant to developing effective team-based care are found in complexity theory. 16,17 It highlights the interdependency among processes of care, system infrastructure, and provider relationships.…”

Section: Resident Pactmentioning

confidence: 99%

Exploring End-of-Residency Transitions in a VA Patient Aligned Care Team

et al. 2014

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BACKGROUND: End-of-residency transitions create disruptions in primary care continuity. The national implementation of Patient Aligned Care Teams (PACT) in Veterans Health Administration (VA) primary care clinics creates an opportunity to mitigate this discontinuity through the provision of teambased care. OBJECTIVES: To identify team-based solutions to endof-residency transitions in a resident PACT continuity clinic by assessing the knowledge, attitudes, and perceptions of non-physician PACT members and resident PACT physicians. DESIGN AND PARTICIPANTS: Cross-sectional survey of 27 resident physicians and 24 non-physician PACT members in the Internal Medicine Clinic at the Audie L. Murphy VA Hospital in the South Texas Veterans Health Care System. RESULTS: Twenty-seven residents and 24 non-physician PACT members completed the survey, with response rates of 90 % and 100 %, respectively. All residents and 96 % of non-physician PACT members agreed or strongly agreed that the residents were responsible for informing patients about end-of-residency transitions. Only 38 % of non-physician PACT members versus 52 % of residents indicated that non-physician PACT members should be responsible for this transition. Approximately 80 % of resident physicians and non-physician PACT members agreed there should be a formalized approach to these transitions; 67 % of non-physician PACT members were willing to support this transition. Potential barriers to team-based care transitions were identified. Major themes of write-in suggestions for improving the transition focused on communication and relationships between the patient and PACT and among the PACT members. CONCLUSIONS: PACT implementation changes the roles and relationship structures among all team members. While end-of-residency transitions create a disruption in the relationship system, the remainder of the PACT may bridge this transition. Our results demonstrate the importance of a team-based solution that engages all PACT members by improving communication and fostering effective team relationships.

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Medical Home Features of VHA Primary Care Clinics and Avoidable Hospitalizations

Cited by 31 publications

References 18 publications

Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care

Effects of a Medical Home and Shared Savings Intervention on Quality and Utilization of Care

“We’ve Not Gotten Even Close to What We Want to Do”: a Qualitative Study of Early Patient-Centered Medical Home Implementation

Exploring End-of-Residency Transitions in a VA Patient Aligned Care Team

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