title: Impact of Patient-Centered Care Innovations on Access to Providers, Ambulatory Care Utilization, and Patient Clinical Indicators in the Veterans Health Administration.
abstract: BACKGROUND
  The Veterans Health Administration piloted patient-centered care (PCC) innovations beginning in 2010 to improve patient and provider experience and environment in ambulatory care. We use secondary data to look at longitudinal trends, evaluate system redesign, and identify areas for further quality improvement.
  
  
  METHODS
  This was a retrospective, observational study using existing secondary data from multiple US Department of Veteran Affairs sources to evaluate changes in veteran and facility outcomes associated with PCC innovations at 2 innovation and matched comparison sites between FY 2008-2010 (pre-PCC innovations) and FY 2011-2012 (post-PCC innovations). Outcomes included access to primary care providers (PCPs); primary, specialty, and emergency care use; and clinical indicators for chronic disease.
  
  
  RESULTS
  Longitudinal trends revealed a different story at each site. One site demonstrated better PCP access, decrease in emergency and primary care use, increase in specialty care use, and improvement in diabetic glucose control. The other site demonstrated a decrease in PCP access and primary care use, no change in specialty care use, and an increase in diastolic blood pressure in relation to the comparison site.
  
  
  CONCLUSIONS
  Secondary data analysis can reveal longitudinal trends associated with system changes, thereby informing program evaluation and identifying opportunities for quality improvement.
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Health Services Research & Development, Hines VA Hospital (Drs Burkhart, Sohn, Jordan, Tarlov, and LaVela and Ms Gampetro), and Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP) (Drs Burkhart, Sohn, Jordan, Tarlov, and LaVela and Ms Gampetro), Department of Veterans Affairs, Hines, Illinois; Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, Illinois (Dr Burkhart and Ms Gampetro); Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville (Dr Sohn); Department of Psychiatry and Behavioral Sciences (Dr Jordan) and Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics (Dr LaVela), Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Department of Health Systems Science, College of Nursing, University of Illinois-Chicago (Dr Tarlov).
authors.forename: Lisa
authors.initials: L
authors.lastname: Burkhart
authors.forename: Min-Woong
authors.initials: MW
authors.lastname: Sohn
authors.forename: Neil
authors.initials: N
authors.lastname: Jordan
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tarlov
authors.forename: Pamela
authors.initials: P
authors.lastname: Gampetro
authors.forename: Sherri L
authors.initials: SL
authors.lastname: LaVela
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003266:Continuity of Patient Care / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D009936:Organizational Innovation; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration