Faculty Collaboration Database

What are the key elements for implementing intensive primary care? A multisite Veterans Health Administration case study. Healthc (Amst) 2018 Dec;6(4):231-237

Date

11/06/2017

Pubmed ID

29102480

DOI

10.1016/j.hjdsi.2017.10.001

Scopus ID

2-s2.0-85033470026 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

Many integrated health systems and accountable care organizations have turned to intensive primary care programs to improve quality of care and reduce costs for high-need high-cost patients. How best to implement such programs remains an active area of discussion. In 2014, the Veterans Health Administration (VHA) implemented five distinct intensive primary care programs as part of a demonstration project that targeted Veterans at the highest risk for hospitalization. We found that programs evolved over time, eventually converging on the implementation of the following elements: 1) an interdisciplinary care team, 2) chronic disease management, 3) comprehensive patient assessment and evaluation, 4) care and case management, 5) transitional care support, 6) preventive home visits, 7) pharmaceutical services, 8) chronic disease self-management, 9) caregiver support services, 10) health coaching, and 11) advanced care planning. The teams also found that including social workers and mental health providers on the interdisciplinary teams was critical to effectively address psychosocial needs of these complex patients. Having a central implementation coordinator facilitated the convergence of these program features across diverse demonstration sites. In future iterations of these programs, VHA intends to standardize staffing and key features to develop a scalable program that can be disseminated throughout the system.

Author List

Chang ET, Raja PV, Stockdale SE, Katz ML, Zulman DM, Eng JA, Hedrick KH, Jackson JL, Pathak N, Watts B, Patton C, Schectman G, Asch SM

Author

Jeffrey L. Jackson MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Case Management
Case-Control Studies
Humans
Primary Health Care
Program Development
Quality Improvement
Transitional Care
United States
United States Department of Veterans Affairs
Veterans