title: Challenges with Implementing a Patient-Centered Medical Home Model for Women Veterans.
abstract: The Veterans Health Administration (VA) Patient Aligned Care Team (PACT) initiative aims to ensure that all patients receive care consistent with medical home principles. Women veterans' unique care needs and minority status within the VA pose challenges to delivery of equitable, comprehensive primary care for this population. Currently, little is known about whether and/or how PACT should be tailored to better meet women veterans' needs.
  
  
  
  In 2014, we conducted semistructured interviews with 73 primary care providers and staff to examine facilitators and barriers encountered in providing PACT-principled care to women veterans. Respondents were located in eight VA medical centers in eight different states across the United States.
  
  
  
  Respondents perceived PACT as improving continuity of care for patients and as increasing ability of nursing staff to practice at the top of their license. However, the implementation of core medical home features and team huddles was inconsistent and varied both within and across medical centers. Short staffing, inclusion of part-time providers on teams, balancing performance requirements for continuity and same-day access, and space constraints were identified as ongoing barriers to PACT implementation. Challenges unique to care of women veterans included a higher prevalence of psychosocial needs, the need for specialized training of primary care personnel, and short staffing owing to additional sharing of primary care support staff with specialist providers.
  
  
  
  Providers and staff face unique challenges in delivering comprehensive primary care to women veterans that may require special policy, practice, and management action if benefits of PACT are to be fully realized for this population.
authors.affiliation: Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California. Electronic address: emchuang@ucla.edu.
authors.forename: Emmeline
authors.initials: E
authors.lastname: Chuang
authors.affiliation: Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
authors.forename: Julian
authors.initials: J
authors.lastname: Brunner
authors.affiliation: Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
authors.forename: Selene
authors.initials: S
authors.lastname: Mak
authors.affiliation: HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California.
authors.forename: Alison B
authors.initials: AB
authors.lastname: Hamilton
authors.affiliation: HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California.
authors.forename: Ismelda
authors.initials: I
authors.lastname: Canelo
authors.affiliation: HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California.
authors.forename: Jill
authors.initials: J
authors.lastname: Darling
authors.affiliation: Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California.
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
authors.affiliation: Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Health Care System, Los Angeles, California.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
mesh_terms: D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D009726:Nurses; D010348:Patient Care Team; D018802:Patient-Centered Care / Q000458:organization & administration*; D058007:Physicians, Primary Care; D036301:Qualitative Research; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D014932:Women's Health Services / Q000458:organization & administration*