title: Developing a toolkit for panel management: improving hypertension and smoking cessation outcomes in primary care at the VA.
abstract: BACKGROUND
  As primary care practices evolve into medical homes, there is an increasing need for effective models to shift from visit-based to population-based strategies for care. However, most medical teams lack tools and training to manage panels of patients. As part of a study comparing different approaches to panel management at the Manhattan and Brooklyn campuses of the VA New York Harbor Healthcare System, we created a toolkit of strategies that non-clinician panel management assistants (PMAs) can use to enhance panel-wide outcomes in smoking cessation and hypertension.
  
  
  METHODS
  We created the toolkit using: 1) literature review and consultation with outside experts, 2) key informant interviews with staff identified using snowball sampling, 3) pilot testing for feasibility and acceptability, and 4) further revision based on a survey of primary care providers and nurses. These steps resulted in progressively refined strategies for the PMAs to support the primary care team.
  
  
  RESULTS
  Literature review and expert consultation resulted in an extensive list of potentially useful strategies. Key informant interviews and staff surveys identified several areas of need for assistance, including help to manage the most challenging patients, providing care outside of the visit, connecting patients with existing resources, and providing additional patient education. The strategies identified were then grouped into 5 areas - continuous connection to care, education and connection to clinical resources, targeted behavior change counseling, adherence support, and patients with special needs.
  
  
  CONCLUSIONS
  Although panel management is a central aspect of patient-centered medical homes, providers and health care systems have little guidance or evidence as to how teams should accomplish this objective. We created a toolkit to help PMAs support the clinical care team for patients with hypertension or tobacco use. This toolkit development process could readily be adapted to other behaviors or conditions.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT01677533.
authors.forename: Stella M
authors.initials: SM
authors.lastname: Savarimuthu
authors.affiliation: VA New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010, USA. ashley.jensen@va.gov.
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Jensen
authors.forename: Antoinette
authors.initials: A
authors.lastname: Schoenthaler
authors.forename: Anne
authors.initials: A
authors.lastname: Dembitzer
authors.forename: Craig
authors.initials: C
authors.lastname: Tenner
authors.forename: Colleen
authors.initials: C
authors.lastname: Gillespie
authors.forename: Mark D
authors.initials: MD
authors.lastname: Schwartz
authors.forename: Scott E
authors.initials: SE
authors.lastname: Sherman
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care / Q000379:methods*; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D058996:Quality Improvement; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation; D014481:United States; D014493:United States Department of Veterans Affairs