Abstract
Geriatric Patient-Aligned Care Teams (GeriPACT) were implemented in the Department of Veterans Affairs (VA) (i.e., Patient-Centered Medical Homes for older adults) to provide high quality coordinated care to older adults with more risk of negative health and psychosocial outcomes. The objectives of this paper are: (1) to present data on GeriPACT structural characteristics; and (2) to examine a composite measure of GeriPACT model consistency. We utilized a web survey targeting 71 physician leads resulting in a 62% response rate. We found GeriPACTs employed a range of staffing, empanelment, clinic space, and patient assignment practices. The mean value of the GeriPACT consistency measure was 2.03 (range: 1–4) and 6.3% of facilities were considered consistent to the GeriPACT model. We observed large variation in GeriPACT structure and in model consistency. More research is needed to understand how these variations are related to processes and outcomes of care.
Highlights
The Patient-Centered Medical Home (PCMH) model was developed to provide more timely access, coordination and patient-centered care in primary care settings
To assess the GeriPACT structural characteristics across VA medical centers (VAMCs), we developed a survey based on the critical program components described in the GeriPACT Handbook [7]
The objective of our analysis was to evaluate the range and fidelity with which GeriPACT are implemented across Veterans Affairs (VA) by: (1) depicting data on individual GeriPACT structural characteristics; and (2) examining a composite measure to assess the extent to which medical centers were consistent with the GeriPACT model that is outlined in the VA’s Handbook
Summary
The Patient-Centered Medical Home (PCMH) model was developed to provide more timely access, coordination and patient-centered care in primary care settings. Geriatrics 2018, 3, 46 the success of PCMH has been mixed, some research has shown PCMH implementation was related to slightly better clinical outcomes [1,2,3]. PCMH was not designed with the unique needs of an older adult population in mind. The multiple interacting cognitive, functional, psychosocial, and medical challenges of older adults may surmount the capacity of a typical PCMH [4]. About three-quarters of Americans who are 65 and older have multiple chronic conditions that require ongoing medical attention or limit activities of daily living [5] In addition, older patients can experience geriatric syndromes that require more intensive care management, such as dementia and frailty. Older adults deal with psychosocial issues such as living alone, and/or geographic isolation, in relationship to family or in terms of rurality, which tend to negatively impact older adults in ways that they might not have imagined at earlier ages
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