title: A First Look at PCMH Implementation for Minority Veterans: Room for Improvement.
abstract: BACKGROUND
  Implementation of Patient Aligned Care Teams (PACT), a patient-centered medical home model, has been inconsistent among the >900 primary care facilities in the Veterans Health Administration.
  
  
  OBJECTIVE
  Estimate if the degree of PACT implementation at a facility varied with the percentage of minority veteran patients at the facility.
  
  
  METHODS
  Cross-sectional, facility-level analysis of PACT implementation measures in 2012.
  
  
  METHODS
  Veterans Health Administration hospital-based and community-based primary care facilities.
  
  
  METHODS
  We used a previously validated PACT Implementation Progress Index (Pi) and its 8 domains: access, continuity of care, care coordination, comprehensiveness, self-management support, and patient-centered care and communication, shared decision-making domains, and team functioning. Facilities were categorized as low (<5.2%, n=208), medium (5.2%-25.8%, n=413), and high (>25.8%, n=206) percent minority based on the percent of their own veteran population.
  
  
  RESULTS
  Most minority veterans received care in high minority (69%) and medium minority facilities (29%). In adjusted analyses, medium and high minority facilities scored 0.773 (P=0.009) and 0.930 (P=0.008) points lower on the Pi score relative to low minority facilities. Relative to low minority facilities, both medium and high minority facilities were less likely of having high Pi scores (≥2) and more likely of having low Pi scores (≤-2). Both medium and high minority facilities had the same 3 domain scores lower than low minority facilities (care coordination, comprehensiveness, and self-management).
  
  
  CONCLUSIONS
  Overall PACT implementation varied with respect to the racial/ethnic composition of a facility, with medium and high minority facilities having a lower implementation scores.
authors.affiliation: *Department of Health Services, School of Public Health, University of Washington †Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA, Puget Sound Health Care System, Seattle, WA ‡Institute for Better Health, Trillium Health Partners, Toronto Canada §General Internal Medicine Service, VA Puget Sound Health Care System ∥Department of Medicine, University of Washington School of Medicine, Seattle, WA ¶Office of Analytics and Business Intelligence, Veterans Health Administration, Washington, DC.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hernandez
authors.forename: Leslie
authors.initials: L
authors.lastname: Taylor
authors.forename: David
authors.initials: D
authors.lastname: Grembowski
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
authors.forename: Edwin
authors.initials: E
authors.lastname: Wong
authors.forename: Karin M
authors.initials: KM
authors.lastname: Nelson
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hebert
mesh_terms: D000367:Age Factors; D000368:Aged; D003142:Communication; D003266:Continuity of Patient Care / Q000458:organization & administration; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000458:organization & administration; D010358:Patient Participation; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D012111:Residence Characteristics; D012648:Self Care; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D014728:Veterans / Q000706:statistics & numerical data*; D058014:Veterans Health