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The experience of Patient Aligned Care Team (PACT) members

Ladebue, Amy C.; Helfrich, Christian D.; Gerdes, Zachary T.; Fihn, Stephan D.; Nelson, Karin M.; Sayre, George G.

doi: 10.1097/HMR.0000000000000048
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Background: In April 2010, the Veterans Health Administration (VHA) launched the Patient Aligned Care Team (PACT) initiative to implement a patient-centered medical home (PCMH) model. Few evaluations have addressed the effects of PCMH on health care professionals’ experiences.

Purposes: The aim of this study was to contribute to evaluation of the PACT initiative and the broader literature on PCMH by assessing respondents’ experiences of implementing a PCMH model and becoming a teamlet.

Methodology/Approach: A retrospective qualitative analysis of open-text responses in a survey fielded to all VHA Primary Care personnel (VHA Primary Care physicians, nurse practitioners, physician assistants, nurse care managers, clinical associates, and administrative clerks) in May and June 2012 (approximately 2 years into the 5-year planned implementation of PACT) using deductive and inductive content analysis. The main measures were two open-response fields: “Is there anything else you would like us to relay to the VA leadership in Central Office?” and “Do you have any other comments or feedback on PACT?” The data consisted of free text responses of 3,868 survey participants who provided text for one or both of the open-response fields.

Findings: Although respondents viewed PACT positively as a model and reported it improved relationships with patients and increased patient satisfaction, they described multiple barriers to achieving functioning teamlets and unintended consequences, including reduced time with patients, increased participant burnout, and decreased team efficacy because of low-performing team members. A central theme related to staffing being insufficient for the new model.

Practice Implications: Insufficient staffing of PCMH teams is a critical barrier to realizing the benefits of the new model. Frontline staff have concrete recommendations for other problems, such as using back-up teams to cover during absences, but that will require providing more opportunities for feedback from staff to be heard.

Amy C. Ladebue, BA, is Research Assistant, Health Services Research and Development Center for Innovation for Veteran-Centered and Value-Driven Care, College of Arts and Sciences, Seattle University, Washington.

Christian D. Helfrich, MPH, PhD, is Research Investigator, Health Services Research and Development Center for Innovation for Veteran-Centered and Value-Driven Care, and Research Assistant Professor, Department of Health Services, University of Washington, Seattle.

Zachary T. Gerdes, BA, is Research Assistant, Health Services Research and Development Center for Innovation for Veteran-Centered and Value-Driven Care, and Doctoral Student, Department of Psychology, University of Akron, Ohio.

Stephan D. Fihn, MD, MPH, is Director, Office of Analytics and Business Intelligence, U.S. Department of Veterans Affairs, Seattle, Washington, Professor and Head, Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, and Professor, Department of Health Services, University of Washington, Seattle.

Karin M. Nelson, MD, MSHS, is Staff Physician, Health Services Research and Development Center for Innovation for Veteran-Centered and Value-Driven Care, and Associate Professor, Department of Medicine, University of Washington, Seattle.

George G. Sayre, PsyD, is Health Science Researcher and Qualitative Resources Coordinator, Health Services Research and Development Center for Innovation for Veteran-Centered and Value-Driven Care, and Clinical Assistant Professor, Department of Health Services, University of Washington, Seattle.

Authors are affiliated with the VA and this work was funded by the VA Office of Patient Care Services. The views expressed here do not necessarily reflect the position or policy of the Department of Veterans Affairs.

The authors are employees or volunteers with the Department of Veterans Affairs, and this work was undertaken through the support of the VA’s Patient Aligned Care Team Demonstration Laboratory initiative.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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