A patient-centered primary care practice approach using evidence-based quality improvement: rationale, methods, and early assessment of implementation.
BACKGROUND
Healthcare systems and their primary care practices are redesigning to achieve goals identified in Patient-Centered Medical Home (PCMH) models such as Veterans Affairs (VA)'s Patient Aligned Care Teams (PACT). Implementation of these models, however, requires major transformation. Evidence-Based Quality Improvement (EBQI) is a multi-level approach for supporting organizational change and innovation spread.


OBJECTIVE
To describe EBQI as an approach for promoting VA's PACT and to assess initial implementation of planned EBQI elements.


METHODS
Descriptive.


METHODS
Regional and local interdisciplinary clinical leaders, patient representatives, Quality Council Coordinators, practicing primary care clinicians and staff, and researchers from six demonstration site practices in three local healthcare systems in one VA region.


METHODS
EBQI promotes bottom-up local innovation and spread within top-down organizational priorities. EBQI innovations are supported by a research-clinical partnership, use continuous quality improvement methods, and are developed in regional demonstration sites.


METHODS
We developed a logic model for EBQI for PACT (EBQI-PACT) with inputs, outputs, and expected outcomes. We describe implementation of logic model outputs over 18 months, using qualitative data from 84 key stakeholders (104 interviews from two waves) and review of study documents.


RESULTS
Nearly all implementation elements of the EBQI-PACT logic model were fully or partially implemented. Elements not fully achieved included patient engagement in Quality Councils (4/6) and consistent local primary care practice interdisciplinary leadership (4/6). Fourteen of 15 regionally approved innovation projects have been completed, three have undergone initial spread, five are prepared to spread, and two have completed toolkits that have been pretested in two to three sites and are now ready for external spread.


CONCLUSIONS
EBQI-PACT has been feasible to implement in three participating healthcare systems in one VA region. Further development of methods for engaging patients in care design and for promoting interdisciplinary leadership is needed.
VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, VA Greater Los Angeles, 16111 Plummer Street, North Hills, CA, 91343, USA, lisa.rubenstein@va.gov.
Lisa V
LV
Rubenstein
Susan E
SE
Stockdale
Negar
N
Sapir
Lisa
L
Altman
Timothy
T
Dresselhaus
Susanne
S
Salem-Schatz
Susan
S
Vivell
John
J
Ovretveit
Alison B
AB
Hamilton
Elizabeth M
EM
Yano
D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards* / Q000639:trends; D006801:Humans; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards* / Q000639:trends; D011320:Primary Health Care / Q000379:methods / Q000592:standards* / Q000639:trends; D058996:Quality Improvement / Q000592:standards* / Q000639:trends; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards* / Q000639:trends