05:22pm Saturday 06 June 2020

Care model linked to improved veteran care; more access, use of e-records, post hospital follow-up

ANN ARBOR, Mich. —   As a growing number of health care organizations in the country turn to a national model of “patient-centered” care, a new study provides insight into how well one of the largest examples of these initiatives has impacted health services. 

Since 2010, shifts in care across the Department of Veteran Affairs’ 978 primary care sites were linked to a tenfold increase in telephone and online interactions between patients and providers, a rise in patient use of electronic personal health records from 3 percent to 13 percent, and an increase in nurse follow-up with patients within 48 hours post hospitalization from 7 percent to 61 percent. 

Over the same period, the VA has seen increased rates of same-day patient access to primary care providers, continuity of care with assigned primary providers, use of nurse-facilitated home tele-monitoring of chronic conditions, and group patient visits, according to the study. The findings appear in American Journal of Managed Care.

“The VA has invested a significant 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,” says study lead author by Ann-Marie Rosland, M.D., M.S., assistant professor in the Department of Internal Medicine at the University of Michigan Medical School and research investigator for the Center for Clinical Management Research in the VA Ann Arbor Healthcare System.

Ann-Marie Rosland, M.D.

Ann-Marie Rosland, M.D.

“As the VA enacts further PCMH (patient-centered medical home model) changes, we plan to examine impacts on patient health outcomes, patient satisfaction, and changes in utilization and efficiency. Hopefully this will 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.”

VA improvements followed three-years of starting its Patient Aligned Care Teams (PACT) initiative, following the national model of care known as patient-centered medical home. PCMH, which aims to provide more comprehensive, coordinated, and patient-centered care, 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 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. 

The initiative led to a dramatic increase in primary care support staff at the VA, which hired more than 1,200 nurse care managers since January 2010 to lay the foundation for PACT.

Rosland and colleagues from the Ann Arbor VA, along with researchers from VA Puget Sound and the Veterans Health Administration Office of Analytics and Business Intelligence, examined data on care of more than 5 million primary care patients from 2009 (pre-PACT) to June 2012 (approximately mid-way through PACT’s roll-out). 

VHA will continue to implement PACT changes through 2014. More information about VA’s Patient-Aligned Care Team model can be found at: http://www.va.gov/PRIMARYCARE/PACT/index.asp
Additional authors:  Karin Nelson, M.D., M.S.H.S.; Haili Sun, Ph.D.; Emily D. Dolan, Ph.D.; Charles Maynard, Ph.D.; Christopher Bryson, M.D., M.S.; Richard Stark, M.D.; Joanne Shear, M.S., R.N.P.; Eve Kerr, M.D., M.P.H.; Stephan D. Fihn, M.D., M.P.H.; and Gordon Schectman, M.D.

Disclosures: None

Funding:  VA PACT National Coordinating Center and VA Health Services Research & Development service.

Reference: “The Patient-Centered Medical Home in the Veterans Health Administration,” American Journal of Managed Care, Vol.19, No.7.

Additional Resources:

Patient Centered Medical Home: http://www.pcpcc.net/about/medical-home

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