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

Bidassie, Balmatee

doi:10.5772/66415

Cited by 4 publications

(3 citation statements)

References 78 publications

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“…[29][30][31] Although the PACT model is a national VHA initiative, its policies and practices are shaped and implemented at national, regional, and local levels across the more than 1,000 VHA primary care practices nationally, 29 resulting both in flexibility but also variability in implementation. Although the PACT model is associated with improved provider experience, 32 VHA primary care remains an time-constrained environment susceptible to provider burnout like other primary care settings nationally. 33…”

Section: Vha Model Of Primary Care Deliverymentioning

confidence: 99%

Introducing return of results in the Million Veteran Program: Design and pilot results of the MVP-ROAR Familial Hypercholesterolemia Study

Vassy,

Brunette,

et al. 2023

Preprint

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BackgroundAs a mega-biobank linked to a national healthcare system, the Million Veteran Program (MVP) can directly improve the health care and health outcomes of participants. Return of genetic research results at this scale presents challenges and complexities.MethodsTo determine the feasibility and outcomes of returning medically actionable genetic results to MVP participants, the program launched the MVP Return Of Actionable Results (MVP-ROAR) Study, with familial hypercholesterolemia (FH) as the exemplar actionable condition. The MVP-ROAR-FH Study consists of a completed pilot phase and an ongoing randomized clinical trial (RCT), in which MVP participants are recontacted and invited to receive clinical confirmatory gene sequencing testing and a telegenetic counseling intervention. The primary outcome of the RCT is 6-month change in low-density lipoprotein cholesterol (LDL-C) between participants receiving results at baseline and those receiving results after 6 months.ResultsNine MVP participants suspected to have a pathogenic variant inlow-density lipoprotein receptor(LDLR) enrolled in the single-arm pilot phase of the study; one was lost to follow-up prior to confirmatory testing. Clinical sequencing confirmed the pathogenic variant for 5 of the remaining 8 participants. Six-month ΔLDL-C among enrollees after the genetic counseling intervention was −37 mg/dL (95% CI: −12 to −61;p=0.03).ConclusionsWhile underscoring the importance of analytic validity and clinical confirmation of research results, the pilot phase of the MVP-ROAR-FH Study demonstrates the feasibility of a protocol to return genetic results to MVP participants and their providers. The ongoing RCT will contribute to understanding of how such a program might improve patient health care and outcomes.

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Section: Vha Model Of Primary Care Deliverymentioning

confidence: 99%

Introducing return of results in the Million Veteran Program: Design and pilot results of the MVP-ROAR Familial Hypercholesterolemia Study

Vassy,

Brunette,

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…In VA, primary care is delivered via Patient Aligned Care Teams (PACTs), VA's version of the patient-centered medical home model, in which primary care providers (PCPs) are closely supported by registered nurses (RNs) serving as care managers. 22 VA uses five tiers to categorize "complexity" of its healthcare systems based on services available, patient population, and education and research activities; 23 the Spokane HCS is in the lowest complexity tier.…”

Section: Settingmentioning

confidence: 99%

Cerner Millennium’s Care Pathways for Specialty Care Referrals: Provider and Nurse Experiences, Perceptions, and Recommendations for Improvements

Cordasco,

Gable,

Ganz

et al. 2023

J GEN INTERN MED

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Background Using structured templates to guide providers in communicating key information in electronic referrals is an evidence-based practice for improving care quality. To facilitate referrals in Veterans Health Administration’s (VA) Cerner Millennium electronic health record, VA and Cerner have created “Care Pathways”—templated electronic forms, capturing needed information and prompting ordering of appropriate pre-referral tests. Objective To inform their iterative improvement, we sought to elicit experiences, perceptions, and recommendations regarding Care Pathways from frontline clinicians and staff in the first VA site to deploy Cerner Millennium. Design Qualitative interviews, conducted 12–20 months after Cerner Millennium deployment. Participants We conducted interviews with primary care providers, primary care registered nurses, and specialty providers requesting and/or receiving referrals. Approach We used rapid qualitative analysis. Two researchers independently summarized interview transcripts with bullet points; summaries were merged by consensus. Constant comparison was used to sort bullet points into themes. A matrix was used to view bullet points by theme and participant. Results Some interviewees liked aspects of the Care Pathways, expressing appreciation of their premise and logic. However, interviewees commonly expressed frustration with their poor usability across multiple attributes. Care Pathways were reported as being inefficient; lacking simplicity, naturalness, consistency, and effective use of language; imposing an unacceptable cognitive load; and not employing forgiveness and feedback for errors. Specialists reported not receiving the information needed for referral triaging. Conclusions Cerner Millennium’s Care Pathways, and their associated organizational policies and processes, need substantial revision across several usability attributes. Problems with design and technical limitations are compounding challenges in using standardized templates nationally, across VA sites having diverse organizational and contextual characteristics. VA is actively working to make improvements; however, significant additional investments are needed for Care Pathways to achieve their intended purpose of optimizing specialty care referrals for Veterans.

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“…Through Patient Aligned Care Teams (PACTs), pharmacists independently operate their own specialty clinics (e.g., diabetes, heart failure, anticoagulation, HIV/HCV), order essential labs, prescribe appropriate or discontinue inappropriate medications, and have patients follow up with teammates. [9][10][11] Pharmacist-operated clinics have produced significant beneficial patient outcomes, especially since pharmacists provide a unique repertoire of skills, particularly regarding medications, motivational interviewing, and adherence. 5,[12][13][14][15][16][17][18][19][20] Similar practices can be seen through collaborative drug therapy management (CDTM) in New York.…”

mentioning

confidence: 99%

NYSCHP Joe Pinto Resident Essay Award Application

Maniara

2019

Journal of Pharmacy Practice

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

Abstract: Objective: Conduct a literature review on existing patient-centered medical home (PCMH) models and outline the differences and contributions.

Cited by 4 publications

References 78 publications

Introducing return of results in the Million Veteran Program: Design and pilot results of the MVP-ROAR Familial Hypercholesterolemia Study

Introducing return of results in the Million Veteran Program: Design and pilot results of the MVP-ROAR Familial Hypercholesterolemia Study

Cerner Millennium’s Care Pathways for Specialty Care Referrals: Provider and Nurse Experiences, Perceptions, and Recommendations for Improvements

NYSCHP Joe Pinto Resident Essay Award Application

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