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Impact of Patient-Centered Care Innovations on Access to Providers, Ambulatory Care Utilization, and Patient Clinical Indicators in the Veterans Health Administration

Burkhart, Lisa PhD, RN, ANEF; Sohn, Min-Woong PhD; Jordan, Neil PhD; Tarlov, Elizabeth PhD, RN; Gampetro, Pamela MS, APN-BC; LaVela, Sherri L. PhD, MBA, MPH

Quality Management in Health Care: April/June 2016 - Volume 25 - Issue 2 - p 102–110
doi: 10.1097/QMH.0000000000000093
Quality Improvement and Health Care Reform Initiatives: Original Article

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.

Conclusion: Secondary data analysis can reveal longitudinal trends associated with system changes, thereby informing program evaluation and identifying opportunities for quality improvement.

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).

Correspondence: Lisa Burkhart, PhD, RN, ANEF, Marcella Niehoff School of Nursing, Loyola University Chicago, 1032 W. Sheridan Rd, 912 BVM Hall, Chicago, IL 60660 (

Veterans Health Administration Office of Patient Centered Care and Cultural Transformation and the Quality Enhancement Improvement Initiative (PCE 13-002, PI: Dr LaVela).

The authors declare no conflicts of interest.

© 2016Wolters Kluwer Health | Lippincott Williams & Wilkins