Patient Aligned Care Team Model Research Articles

Perceptions of Responsibilities by Primary Care Staff in a Patient-Centered Medical Home.

To examine the extent to which Veterans Health Administration (VHA) Patient-Aligned Care Team (PACT) members have a shared understanding/ agreement upon and enact responsibilities within the team. The PACT model focuses on team-based care management. However, lack of a shared understanding of team-based care management roles and responsibilities makes system-wide implementation a challenge. Quantitative and qualitative analysis of national survey data collected in 2022 from primary care personnel working in a VHA-affiliated primary care facility. Significant discrepancies exist in responses about what core team members say they do and what others perceive they should be doing, indicating either a lack of agreement, knowledge, or training about what core team members should do. Successful implementation of a team-based model requires adequate support and training for teamwork including shared mental models to work according to their clinical competency. Clear guidance and communication of expectations are critical for role clarity.

Optimizing the primary care clinical pharmacy specialist: Increasing patient access and quality of care within the Veterans Health Administration

AbstractBackgroundAccess to high‐quality care is a US Department of Veterans Affairs (VA) top priority. The VA utilized the principles of the Patient Centered Medical Home model to design the Patient‐Aligned Care Team (PACT) to deliver primary care to our nation's Veterans. The PACT model was introduced in the VA in 2009 and was implemented across the health care system in 2010.ObjectiveThis review will highlight how the VA clinical pharmacy specialist (CPS) have been integrated throughout the VA to provide clinical care services in the primary care setting. CPSs in PACTs provide comprehensive medication management (CMM) in between typical PACT provider visits to initiate, modify, or discontinue medications, as well as providing disease management in foundational and high‐volume areas such as anticoagulation, pain management, diabetes, hypertension, anemia, chronic obstructive pulmonary disease, heart failure, hepatitis C, and hyperlipidemia.ConclusionsWithin the VA, CPSs work autonomously but collaboratively under a global or practice area‐based scope of practice (SOP) with prescriptive authority. VA CPS serving as a provider in primary care increase access and quality of care to veterans through the provision of CMM. This model has the opportunity to be leveraged in other health care systems.

The role of the psychologist in the veterans administration's patient aligned care team and huddle: A review, practical recommendations, and a call to action.

The Veterans Administration (VA)’s Patient Aligned Care Team (PACT) model has been a cornerstone of primary care in the VA healthcare system and has indicated the need for an organizational cultural shift towards interdisciplinary care. Most of the focus in PACT has been on the traditional providers of the medical model, with little attention focused on the role of the psychologist. This paper examines how psychologists can assist in the PACT model and, in particular, within the team VA huddle. Literature on the PACT model, mental health in PACT, and the advantages of the huddle are reviewed. Lessons learned within a large VA clinic are also discussed. Psychologists’ ability to be a clinician, teambuilder, and system specialist is discussed and how it benefits the PACT and the huddling process. Practical recommendations are made for how to best assist during the huddle, and how to advocate for both the huddle, and for a broader cultural shift in care.

Perceptions of Integration of the Clinical Pharmacist into the Patient Care Medical Home Model.

The patient-centered medical home (PCMH) model is a multidisciplinary, team-based approach to healthcare that focuses on actively involving the patient in clinical decision making. The Veterans Health Administration (VA), while desiring to be a national leader in the delivery of primary care services, used the principles of the PCMH model to design the patient-aligned care team (PACT). The purpose of this study, was to explore the perception of the PACT members after integration of a clinical pharmacist to the PACT. This was a single-center cross-sectional study conducted at an integrated Veterans Health Administration system. We electronically surveyed PACT staff practicing within VA-Tennessee Valley Health Care System as of October 1, 2016 using a modified version of the Medicine Medication Use Processes Matrix (MUPM) containing 19 items on five theoretical grouping of processes (evaluation and management, monitoring, medication review, documentation, and education) and two groupings(clinician satisfaction and access). Ninety-one complete responses were received. Perceptions were positive, with 79% rated as either 4 ("moderate contribution") or 5 ("major contribution"). Individual responses based on discipline, with the exception of the medical support assistant were rated positive, specifically job satisfaction. This study evaluated the perceptions of clinical pharmacist integration into the PACT model. Respondents perceived clinical pharmacist beneficial.

“It goes beyond good camaraderie”: A qualitative study of the process of becoming an interprofessional healthcare “teamlet”

ABSTRACTWithin the US, the patient-centred medical home has become a predominant model in the delivery of primary care. This model requires a shift from the physician-centric model to an interprofessional team-based approach. Thus, healthcare staff are being reorganized into teams, resulting in having to work and relate to one another in new ways. In 2010, the Veterans Health Administration implemented the patient aligned care team (PACT) model, its version of the patient-centred medical home. The transition to the PACT model involved restructuring primary care staff into “teamlets”, consisting of a registered nurse, licensed practical nurse, and administrative clerk for each full-time-equivalent primary care provider. This qualitative study used observation and semi-structured interviews to understand the factors that affect teamlet functioning as they implement this new model of care and how teams are interacting to address those factors. Findings suggest that role understanding includes understanding how each teamlet member’s tasks are performed in the daily operations of the clinic. In addition, willingness to perform tasks that benefit the teamlet and acceptance of delegation from all teamlet members were found to be important for teamlet functioning and cohesion. In order for healthcare teams to provide patient-centred care, it is important to provide guidance and support about what these new relationships and roles will entail. The building of team relationships is not a static process; ways of working together build over time and, therefore, should be seen as a continuous cycle of quality improvement.

Re-designing primary care: Implementation of patient-aligned care teams

BackgroundPrimary care is the foundation of the Department of Veterans Affairs (VA) health care, but transformation efforts are necessary to meet the needs of Veterans and provide patient-centered care (PCC). ProblemThe need to transform the VA from a problem/disease-based provider-driven system to a patient-centered, patient-driven health care system. GoalsOur project objective was to describe the implementation of the Patient-Aligned Care Team (PACT) model in the current Department of Veterans Affairs (VA) health care environment and to identify barriers and facilitators to implementing a new model of care that could apply more broadly to the implementation of large-scale changes in other large integrated health care systems. StrategyWe sought to learn through in-depth interviews with leaders and key informants at several stages of the PACT process, including planning, implementing, modifying where needed, and maintenance. ResultsThe PACT model offers PCC that is managed with high quality, safety, and effectiveness; provides optimal access; and integrates the Veterans’ voice to respect their preferences, needs, and values toward achieving optimal health and well-being. ImplicationsThis transformation in VA provides insight into the barriers and facilitators to implementing large-scale change in an integrated health care system. Implementation of a new model of care across a large integrated health care system requires continuous and highly visible engagement from leadership and staff, distribution of resources across initiatives, and alignment of program goals and performance measures, these lessons.

Orchestrating Large Organizational Change in Primary Care: The Veterans’ Health Administration Experience Implementing a Patient-Centered Medical Home

Orchestrating Large Organizational Change in Primary Care: The Veterans’ Health Administration Experience Implementing a Patient-Centered Medical Home

VA Experience in Implementing Patient-Centered Medical Home Using a Breakthrough Series Collaborative

Veterans Health Administration (VHA) seeks to improve the delivery of patient-centered care. A Patient-Centered Medical Home (PCMH) Model, named Patient Aligned Care Team (PACT), was implemented to transform the VHA primary care delivery process. VHA used a collaborative learning model as a key approach to disseminate PACT concepts and changes. To describe and examine VHA's experience disseminating PACT transformation using a Breakthrough Series Collaborative method. Observational study. Approximately 250-350 individuals from 141 teams participated in six face-to-face learning sessions across 21 months. 1) PACT Collaborative participant surveys; 2) Coach Assessment Scores and Plan-Do-Study-Act (PDSA) data; and 3) PACT Compass (national measures to assess PACT implementation within VA healthcare system). A majority of the participants indicated that the PACT Collaborative was necessary to implement PACT. The number of PDSAs increased steadily during the Collaborative period; 93 % (n = 1,547) of PDSAs were successfully implemented. Teams successfully achieved over 80 % of their aims, which were highly correlated with PDSAs implemented (R(2) = 0.88). The most successful aims achieved were offering same-day appointments, increasing non-face-to-face care, and improving team communication. PACT Compass indicated an improvement after the Collaborative (p-value < .000), and providers observed differences in their care practice (p-value < 0.002). This positive impact may be due to the spread of the PACT Model through the PACT Collaborative, among other learning initiatives. For complex collaborative models such as PACT, more than three learning sessions may be required. As VHA continues to disseminate the PACT Model through primary care, into specialty/surgical care and beyond, the Collaborative Learning Model may continue to be an effective way to leverage a small number of faculty, coaches, and industrial engineers across an extremely large population.

Satisfied patients, pharmacists patients, pharmacists at Phoenix VA

Satisfied patients, pharmacists patients, pharmacists at Phoenix VA