Implementation of the Geriatric Patient-Aligned Care Team Model in the Veterans Health Administration (VA)

Journal of the American Board of Family Medicine: JABFM

Rina Eisenstein^1¹  Thomas Price^1³  Kenneth Shay^1⁴  Samantha Solimeo^1⁶  Jennifer L. Sullivan^1⁷ 

[1] 2Boston University School of Public Health, Boston, MA (JLS);7 US Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, D.C. (KS)^1;Atlanta Veterans Affairs Medical Center, Atlanta, GA (RE, TP);Center for Comprehensive Access & Delivery Research & Evaluation Center and the VISN 23 Patient Aligned Care Team PACT Demonstration Laboratory, Iowa City VA Health Care System, Iowa City, IA (SS);Department of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City (SS);Section of Geriatric Medicine and Gerontology, Emory University School of Medicine, Atlanta (RE, TP);From Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System (JLS)

关键词: Implementation;    Patient-Centered Medical Home;    Primary Health Care;    Geriatrics;   

DOI  :  10.3122/jabfm.2018.03.170272

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Background: Here, we describe the implementation of a specialty primary care medical home (PCMH) model called Geriatric Patient-Aligned Care Teams (GeriPACT) in the Veterans' Health Administration (VA) that is focused on serving older complex patients. In particular, our aims in this article are to describe how the GeriPACT model was developed and implemented in VA sites, provide a closer look at how GeriPACT functions by presenting a case study, and highlight data showing national variation in the implementation of GeriPACT staffing models and PCMH practices. Methods: Stakeholder feedback regarding the GeriPACT model was obtained from a GeriPACT team and the director of GeriPACT in VA. Here, we present national data regarding variations in GeriPACT staffing and PCMH practices. Results: Following the adoption and implementation of the GeriPACT model and release of the GeriPACT handbook, sites were able to adopt the model's principles. The VA's adoption of PCMH reinforced the mission of patient-centered primary care by integrating psychosocial and environmental determinants of health. This was accomplished with enhancements to staff support through new full-time employment equivalents, but also by optimizing staff productivity through improved team function and interpersonal care. The GeriPACT model was implemented in a bottom-up fashion that has led to variation in how GeriPACTs are structured and staffed, as well as how they conform to various PCMH principles. Conclusions: GeriPACT is one approach for bringing an interdisciplinary, patient-centric perspective to primary care in a manner that can likely support the higher staffing costs with economies realized from diminished reliance on institutional placement and highly technologic health care. It is a model which can provide training for the next generation of providers and clinicians.

【 授权许可】

CC BY