title: Panel Management to Improve Smoking and Hypertension Outcomes by VA Primary Care Teams: A Cluster-Randomized Controlled Trial.
abstract: BACKGROUND
  Panel Management can expand prevention and chronic illness management beyond the office visit, but there is limited evidence for its effectiveness or guidance on how best to incorporate it into practice.
  
  
  OBJECTIVE
  We aimed to test the effectiveness of incorporating panel management into clinical practice by incorporating Panel Management Assistants (PMAs) into primary care teams with and without panel management education.
  
  
  METHODS
  We conducted an 8-month cluster-randomized controlled trial of panel management for improving hypertension and smoking cessation outcomes among veterans.
  
  
  METHODS
  Twenty primary care teams from the Veterans Affairs New York Harbor were randomized to control, panel management support, or panel management support plus education groups. Teams included 69 clinical staff serving 8,153 hypertensive and/or smoking veterans.
  
  
  METHODS
  Teams assigned to the intervention groups worked with non-clinical Panel Management Assistants (PMAs) who monitored care gaps and conducted proactive patient outreach, including referrals, mail reminders and motivational interviewing by telephone.
  
  
  METHODS
  Measurements included mean systolic and diastolic blood pressure, proportion of patients with controlled blood pressure, self-reported quit attempts, nicotine replacement therapy (NRT) prescriptions, and referrals to disease management services.
  
  
  RESULTS
  Change in mean blood pressure, blood pressure control, and smoking quit rates were similar across study groups. Patients on intervention teams were more likely to receive NRT (OR = 1.4; 95% CI 1.2-1.6) and enroll in the disease management services MOVE! (OR = 1.2; 95% CI 1.1-1.6) and Telehealth (OR = 1.7, 95% CI 1.4-2.1) than patients on control teams.
  
  
  CONCLUSIONS
  Panel Management support for primary care teams improved process, but not outcome variables among veterans with hypertension and smoking. Incorporating PMAs into teams was feasible and highly valued by the clinical staff, but clinical impact may require a longer intervention.
authors: VA New York Harbor Health Care System, New York, NY, USA, mark.schwartz@nyumc.org.
authors: Mark D
authors: MD
authors: Schwartz
authors: Ashley
authors: A
authors: Jensen
authors: Binhuan
authors: B
authors: Wang
authors: Katelyn
authors: K
authors: Bennett
authors: Anne
authors: A
authors: Dembitzer
authors: Shiela
authors: S
authors: Strauss
authors: Antoinette
authors: A
authors: Schoenthaler
authors: Colleen
authors: C
authors: Gillespie
authors: Scott
authors: S
authors: Sherman
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D019468:Disease Management; D005260:Female; D006302:Health Services Research; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009518:New York; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D010348:Patient Care Team / Q000458:organization & administration*; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000458:organization & administration*; D016540:Smoking Cessation / Q000379:methods; D000074606:Smoking Prevention; D014728:Veterans / Q000523:psychology*