Multimethod evaluation of the VA's peer-to-peer Toolkit for patient-centered medical home implementation.
BACKGROUND
Effective implementation of the patient-centered medical home (PCMH) in primary care practices requires training and other resources, such as online toolkits, to share strategies and materials. The Veterans Health Administration (VA) developed an online Toolkit of user-sourced tools to support teams implementing its Patient Aligned Care Team (PACT) medical home model.


OBJECTIVE
To present findings from an evaluation of the PACT Toolkit, including use, variation across facilities, effect of social marketing, and factors influencing use.


METHODS
The Toolkit is an online repository of ready-to-use tools created by VA clinic staff that physicians, nurses, and other team members may share, download, and adopt in order to more effectively implement PCMH principles and improve local performance on VA metrics.


METHODS
Multimethod evaluation using: (1) website usage analytics, (2) an online survey of the PACT community of practice's use of the Toolkit, and (3) key informant interviews.


METHODS
Survey respondents were PACT team members and coaches (n = 544) at 136 VA facilities. Interview respondents were Toolkit users and non-users (n = 32).


METHODS
For survey data, multivariable logistic models were used to predict Toolkit awareness and use. Interviews and open-text survey comments were coded using a "common themes" framework. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analyses.


RESULTS
The Toolkit was used by 6,745 staff in the first 19 months of availability. Among members of the target audience, 80 % had heard of the Toolkit, and of those, 70 % had visited the website. Tools had been implemented at 65 % of facilities. Qualitative findings revealed a range of user perspectives from enthusiastic support to lack of sufficient time to browse the Toolkit.


CONCLUSIONS
An online Toolkit to support PCMH implementation was used at VA facilities nationwide. Other complex health care organizations may benefit from adopting similar online peer-to-peer resource libraries.
College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR, 97331-6406, USA, Jeff.luck@oregonstate.edu.
Jeff
J
Luck
Candice
C
Bowman
Laura
L
York
Amanda
A
Midboe
Thomas
T
Taylor
Randall
R
Gale
Steven
S
Asch
D003625:Data Collection / Q000379:methods*; D006801:Humans; D010348:Patient Care Team / Q000592:standards*; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards*; D010380:Peer Review / Q000379:methods / Q000592:standards*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards*