VA experience in implementing Patient-Centered Medical Home using a breakthrough series collaborative.
BACKGROUND
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.


OBJECTIVE
To describe and examine VHA's experience disseminating PACT transformation using a Breakthrough Series Collaborative method.


METHODS
Observational study.


METHODS
Approximately 250-350 individuals from 141 teams participated in six face-to-face learning sessions across 21 months.


METHODS
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).


RESULTS
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.


CONCLUSIONS
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.
Clinical Partnerships in Healthcare Transformation (CPHT), VA Center for Applied Systems Engineering (VA-CASE), VISN11 - Veterans Engineering Resource Center (VERC), Detroit, MI, USA, balmatee.bidassie@va.gov.
Balmatee
B
Bidassie
Michael L
ML
Davies
Richard
R
Stark
Barbara
B
Boushon
D003299:Cooperative Behavior; D006801:Humans; D007857:Leadership; D010348:Patient Care Team / Q000592:standards; D018802:Patient-Centered Care / Q000379:methods* / Q000592:standards; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards