title: The patient-centered medical home in the Veterans Health Administration.
abstract: BACKGROUND
  The Veterans Health Administration (VHA) is the largest integrated US health system to implement the patient-centered medical home. The Patient Aligned Care Team (PACT) initiative (implemented 2010-2014) aims to achieve team based care, improved access, and care management for more than 5 million primary care patients nationwide.
  
  
  OBJECTIVE
  To describe PACT and evaluate interim changes in PACT-related care processes.
  
  
  METHODS
  Data from the VHA Corporate Data Warehouse were obtained from April 2009 (pre- PACT) to September 2012. All patients assigned to a primary care provider (PCP) at all VHA facilities were included.
  
  
  METHODS
  Nonparametric tests of trend across time points.
  
  
  RESULTS
  VHA increased primary care staff levels from April 2010 to December 2011 (2.3 to 3.0 staff per PCP full-time equivalent). In-person PCP visit rates slightly decreased from April 2009 to April 2012 (53 to 43 per 100 patients per calendar quarter; P < .01), while in-person nurse encounter rates remained steady. Large increases were seen in phone encounters (2.7 to 28.8 per 100 patients per quarter; P < .01), enhanced personal health record use (3% to 13% of patients enrolled), and electronic messaging to providers (0.01% to 2.3% of patients per quarter). Post hospitalization follow-up improved (6.6% to 61% of VA hospital discharges), but home telemonitoring (0.8% to 1.4% of patients) and group visits (0.2 to 0.65 per 100 patients per quarter; P < .01) grew slowly.
  
  
  CONCLUSIONS
  Thirty months into PACT, primary care staff levels and phone and electronic encounters have greatly increased; other changes have been positive but slower.
authors.affiliation: VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA. arosland@umich.edu
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Rosland
authors.forename: Karin
authors.initials: K
authors.lastname: Nelson
authors.forename: Haili
authors.initials: H
authors.lastname: Sun
authors.forename: Emily D
authors.initials: ED
authors.lastname: Dolan
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: Christopher
authors.initials: C
authors.lastname: Bryson
authors.forename: Richard
authors.initials: R
authors.lastname: Stark
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Shear
authors.forename: Eve
authors.initials: E
authors.lastname: Kerr
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
authors.forename: Gordon
authors.initials: G
authors.lastname: Schectman
mesh_terms: D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D016208:Databases, Factual; D004059:Diffusion of Innovation; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D010348:Patient Care Team / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D014481:United States; D014493:United States Department of Veterans Affairs