Study Examines Impact of VA Primary Care Patient Centered Medical Home (PCMH) Reorganization

Patient aligned care team model linked to increased access and continuity, telephone and Internet care, patient use of e-records, and post-hospital follow-up

“Patient aligned care team” model linked to increased access and continuity, telephone and Internet care, patient use of e-records, and post-hospital follow-up

WASHINGTON — Since the 2010 start of the Department of Veteran Affairs (VA) PCMH initiative, called Patient Aligned Care Teams (PACT), use of telephone care at VA has increased 10-fold, patient use of electronic personal health records has risen from 3% of all patients to 13%, and primary care nurse follow-up with patients within 48 hours of hospitalization has increased from 7% to 61%. In the same time period, the VA has also seen increased rates of same-day patient access to primary care providers (PCPs), continuity of care with assigned PCPs, use of nurse-facilitated home tele-monitoring of chronic conditions, and group patient visits. These findings will be published in the July 2013 issue of American Journal of Managed Care, in a study that examines shifts in patient access and care as VHA’s enacts PACT across its 978 primary care sites nationwide.

The study, led by Ann-Marie Rosland, MD, MS, and colleagues from the VA Ann Arbor Center for Clinical Management Research, and Kari Nelson, MD, MSHS, and colleagues from the VA Puget Sound and the Veterans Health Administration (VHA) Office of Analytics and Business Intelligence, examined data on care of over 5 million primary care patients from 2009 (pre-PACT) to June 2012 (approximately mid-way through PACT’s roll-out).

“Introducing PACT into VA primary care has already had positive impacts on care coordination, continuity, and access for our Veteran patients,” said Gordon Schectman, MD, Chief Consultant of Primary Care Services for VHA. “Thanks to VHA’s comprehensive electronic health record system and data analysis capabilities, we are able to see as we progress exactly how this patient-centered, team-based approach is influencing patient access, health outcomes, and experience of care. Such information will provide the framework for ongoing improvements in these patient care areas that are critical to the Veterans we serve.”

PCMH is a model for providing primary care of the highest quality, and is endorsed by all major primary care medical societies. While many health systems in the country are putting PCMH into place, VHA is the largest integrated health system to introduce a comprehensive PCMH model system and to do so population-wide, with PACT.

PACT aims to increase care that is highly accessible, comprehensive, and coordinated in order to improve Veterans’ care experiences and health. In PACT, each patient is assigned to a “teamlet,” which consists of a primary care physician, a registered nurse (RN) care manager, a licensed practical nurse (LPN) or medical assistant, and administrative clerk. PACT strategies for improving patient care include introducing advanced-access scheduling with more same-day appointments, conducting more appointments via phone and offering shared medical appointments, increasing patients’ Internet-based access to health information and care providers, and devoting substantial new VA resources towards supporting patients’ healthy lifestyle changes, mental health, and preventive care. As the study also highlights, VA has dramatically increased primary care support staff, hiring over 1,200 nurse care managers since January 2010 to lay the foundation for PACT.

“Ongoing research and evaluation is examining how PACT influences primary care team function, care efficiency, and, most importantly, Veteran health outcomes and Veteran satisfaction with care,” said study author Dr. Nelson “Successes and challenges to implementing sweeping PCMH changes into a large health system also will be evaluated.”

“VA has invested a historic amount of resources and effort into the type of changes in primary care delivery that many other U.S. health care systems are also aspiring to put into place,” added study author Dr. Rosland. “Through this study and others over the next several years, we hope to provide valuable information to VHA facilities that are working to improve Veteran care, as well as other health systems across the nation working to establish a PCMH model.”

VHA will continue to implement PACT changes through 2014.

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Dr. Rosland is a research scientist at the VA Ann Arbor Center for Clinical Management Research and an Assistant Professor of Medicine at University of Michigan. Dr. Nelson is an investigator at the VA Health Services Research and Development Center of Excellence, the Associate Director for the VA PACT National Evaluation at the VA Puget Sound, and an Associate Professor of Medicine at University of Washington. Drs. Rosland and Dr. Nelson are also VA staff physicians in primary care. Data for this report were developed by the national evaluation team at the PACT Demonstration Lab Coordinating Center and the VHA Office of Analytics and Business Intelligence. The VHA Office of Primary Care Operations is responsible for PACT implementation. More information about VA’s Patient-Aligned Care Team model can be found at: http://www.va.gov/PRIMARYCARE/PACT/index.asp. More information about the Patient Centered Medical Home can be found at http://www.pcpcc.net/about/medical-home.