title: Re-designing primary care: Implementation of patient-aligned care teams.
abstract: BACKGROUND
  Primary care is the foundation of the Department of Veterans Affairs (VA) health care, but transformation efforts are necessary to meet the needs of Veterans and provide patient-centered care (PCC).
  
  
  OBJECTIVE
  The need to transform the VA from a problem/disease-based provider-driven system to a patient-centered, patient-driven health care system.
  
  
  OBJECTIVE
  Our project objective was to describe the implementation of the Patient-Aligned Care Team (PACT) model in the current Department of Veterans Affairs (VA) health care environment and to identify barriers and facilitators to implementing a new model of care that could apply more broadly to the implementation of large-scale changes in other large integrated health care systems.
  
  
  METHODS
  We sought to learn through in-depth interviews with leaders and key informants at several stages of the PACT process, including planning, implementing, modifying where needed, and maintenance.
  
  
  RESULTS
  The PACT model offers PCC that is managed with high quality, safety, and effectiveness; provides optimal access; and integrates the Veterans' voice to respect their preferences, needs, and values toward achieving optimal health and well-being.
  
  
  CONCLUSIONS
  This transformation in VA provides insight into the barriers and facilitators to implementing large-scale change in an integrated health care system. Implementation of a new model of care across a large integrated health care system requires continuous and highly visible engagement from leadership and staff, distribution of resources across initiatives, and alignment of program goals and performance measures, these lessons.
authors.affiliation: Department of Veterans Affairs, Edward Hines, Jr. VA Hospital Center for Evaluation of Practices and Experiences of Patient-centered Care (CEPEP) 151-H, Building 1, Office D-312 5th Avenue, Hines, IL 60141, United States; Center of Innovation for Complex Chronic Health Care, HSR&D, Edward Hines Jr. VA Hospital, Hines, IL; Spinal Cord Injury Quality Enhancement Research Initiative, QUERI, Edward Hines Jr. VA Hospital, Hines, IL; Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: Sherri.LaVela@va.gov.
authors.forename: Sherri L
authors.initials: SL
authors.lastname: LaVela
authors.affiliation: Department of Veterans Affairs, Edward Hines, Jr. VA Hospital Center for Evaluation of Practices and Experiences of Patient-centered Care (CEPEP) 151-H, Building 1, Office D-312 5th Avenue, Hines, IL 60141, United States; Center of Innovation for Complex Chronic Health Care, HSR&D, Edward Hines Jr. VA Hospital, Hines, IL; Spinal Cord Injury Quality Enhancement Research Initiative, QUERI, Edward Hines Jr. VA Hospital, Hines, IL.
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Hill
keywords: Implementation research; Patient centered care; Primary care redesign; Quality improvement