Association between Continuity and Team‐Based Care and Health Care Utilization: An Observational Study of Medicare‐Eligible Veterans in VA Patient Aligned Care Team

Reddy, Ashok; Wong, Edwin S.; Canamucio, Anne; Nelson, Karin M.; Fihn, Stephan D.; Yoon, Jean; Werner, Rachel M.

doi:10.1111/1475-6773.13042

Cited by 24 publications

(37 citation statements)

References 30 publications

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“…HBPC care is structured according to the Patient‐Aligned Care Team (PACT) model . Several studies have found evidence for the effectiveness of HBPC and PACT models within and outside of the VA, including fewer hospitalizations and reduced cost and better quality . However, other research has shown higher costs for HBPC care and no significant differences in emergency department visits before or after HBPC enrollment .…”

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confidence: 99%

“…However, other research has shown higher costs for HBPC care and no significant differences in emergency department visits before or after HBPC enrollment . Some studies identified key factors in successfully implementing the PACT model in traditional clinic‐based outpatient primary care settings, including PCP continuity, participatory decision making, enhancement of staff support, improved team function using huddles, involving patients in decision making, and assessing barriers when veterans do not move toward patient goals . In contrast, little is known about strategies HBPC IDTs apply to keep veterans at home and out of institutional care, while accomplishing positive health outcomes.…”

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confidence: 99%

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Dedicated to the Mission: Strategies US Department of Veterans Affairs Home‐Based Primary Care Teams Apply to Keep Veterans at Home

Haverhals

Manheim

Gilman

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES The US Department of Veterans Affairs (VA) Home‐Based Primary Care (HBPC) Program provides interdisciplinary, long‐term primary care for frail, disabled, or chronically ill veterans. This research identifies strategies used by HBPC teams to support veterans in their homes, rather than in institutionalized care. DESIGN Focus groups and semistructured interviews were conducted with HBPC interdisciplinary team (IDT) members, including program directors, medical directors, and key staff, from September 2017 to March 2018. Field observations were gathered during visits to veterans’ homes and IDT meetings. SETTING In‐person site visits were conducted at eight HBPC Programs across the United States. Sites varied in location, setting, and primary care model. PARTICIPANTS A total of 105 HBPC professionals. MEASUREMENT Qualitative thematic content analysis. RESULTS Four main strategies drive and support the shared mission of IDTs to support veterans at home: fostering frequent communication among IDT members, veterans, caregivers, and outside agencies; development of longitudinal, trusting, reliable relationships within IDTs and with veterans and caregivers; ongoing, consistent education for IDT members and veterans and caregivers; and collaboration within and outside IDTs. Adhering to this mission meant providing timely and efficient care that kept veterans in their homes and minimized the need for acute hospitalizations and nursing home placement. CONCLUSION HBPC IDTs studied worked together across disciplines to effectively create a dedicated culture of caring for veterans, caregivers, and themselves, leading to keeping veterans at home. Focusing on the strategies identified in this research may be useful to achieve similar positive outcomes when caring for medically complex, homebound patients within and outside the VA. J Am Geriatr Soc 67:2511–2518, 2019

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confidence: 99%

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confidence: 99%

Dedicated to the Mission: Strategies US Department of Veterans Affairs Home‐Based Primary Care Teams Apply to Keep Veterans at Home

Haverhals

Manheim

Gilman

et al. 2019

J American Geriatrics Society

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“…The papers in this special issue used a range of non-VA datasets, several presented for the first time in a research application. Medicare data were the most commonly linked data (used in Wang et al 2018;Thorpe et al 2018;Vaughan Sarrazin et al 2018;Trivedi et al 2018;Reddy et al 2018;Nelson et al 2018a, b;Vanneman et al 2018;Liu et al 2018;Chui et al 2018;Hebert et al 2018;Lei et al 2018), because these data have been available to VA researchers within the VA under an agreement with Centers for Medicare and Medicaid Services via the VIReC for more than fifteen years and have well-established documentation and file structures (Hynes et al 2007). Other non-VA datasets used by authors in this special issue included US Renal Data System (USRDS) (Wang et al 2018), state data from California birth records (Shaw et al 2018), and Oregon prescription drug monitoring program (PDMP) data (Carlson et al 2018).…”

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confidence: 99%

“…Other non-VA datasets used by authors in this special issue included US Renal Data System (USRDS) (Wang et al 2018), state data from California birth records (Shaw et al 2018), and Oregon prescription drug monitoring program (PDMP) data (Carlson et al 2018). These papers leveraged the linked data they created to address a range of topics, including VA and non-VA health care use and costs (Wang et al 2018;Vaughan Sarrazin et al 2018;Hebert et al 2018;Vanneman et al 2018;Liu et al 2018;Lei et al 2018), medication use (Thorpe et al 2018;Carlson et al 2018;and Chiu et al 2018), and the impact of homelessness on health care use and costs (Nelson et al 2018, andTrivedi et al 2018). One study focused on health care use in VA and VA community care (Rosen et al 2018).…”

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confidence: 99%

“…One study focused on health care use in VA and VA community care (Rosen et al 2018). Clinical conditions addressed included mental health , dementia (Thorpe et al 2018;Lei et al 2018), end-stage kidney disease (Wang et al 2018), pain management (Carlson et al 2018;Chiu et al 2018), high-risk pregnancy (Shaw et al 2018), and infectious disease (Nelson et al 2018). Two studies linked Medicare data to examine the impact of the VA's patient aligned care team intervention Reddy et al 2018).…”

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confidence: 99%

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HSR Commentary: Linking VA and Non‐VA Data to Address Important US Veteran Health Services Research Issues

Hynes

Maciejewski

Atkins

2018

Health Services Research

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Objective This commentary summarizes the methods and topics addressed in the special issue of HSR focused on linkage of United States Department of Veterans Affairs (VA) and non‐VA datasets. The issue illustrates that researchers are increasingly linking diverse datasets as a valuable method for obtaining outcomes, treatments, and covariates to evaluate and examine health care delivery that includes non‐VA services. The issue serves as a reference to VA and non‐VA investigators alike who employ data linkage methods to address high‐impact clinical and health policy evaluations that span different care systems and different datasets.

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Association of High-Cost Health Care Utilization With Longitudinal Changes in Patient-Centered Medical Home Implementation

et al. 2020

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IMPORTANCE In 2010, the US Veterans Health Administration (VHA) implemented one of the largest patient-centered medical home (PCMH) models in the United States, the Patient Aligned Care Team initiative. Early evaluations demonstrated promising associations with improved patient outcomes, but limited evidence exists on the longitudinal association of PCMH implementation with changes in health care utilization. OBJECTIVE To determine whether a change in PCMH implementation is associated with changes in emergency department (ED) visits, hospitalizations for ambulatory care-sensitive conditions (ACSCs), or all-cause hospitalizations. DESIGN, SETTING, AND PARTICIPANTS This cohort study used national patient-level data from the VHA and Centers for Medicare & Medicaid Services between October 1, 2012, and September 30, 2015. A total of 1 650 976 patients from 897 included clinics were divided into 2 cohorts: patients younger than 65 years who received primary care at VHA sites affiliated with a VHA ED and patients 65 years or older who were enrolled in both VHA and Medicare services. EXPOSURES Clinics were categorized on improvement or decline in PCMH implementation based on their Patient Aligned Care Team implementation progress index (Pi 2) score. MAIN OUTCOMES AND MEASURES Change in the number of ED visits, ACSC hospitalizations, and all-cause hospitalizations among patients at each clinic site. RESULTS The study included a total of 1 650 976 patients, of whom 581 167 (35.20%) were younger than 65 years (mean [SD] age, 49.03 [10.28] years; 495 247 [85.22%] men) and 1 069 809 (64.80%) were 65 years or older (mean [SD] age, 74.64 [7.41] years; 1 050 110 [98.16%] men). Among patients younger than 65 years, there were fewer ED visits among patients seen at clinics that had improved PCMH implementation (110.8 fewer visits per 1000 patients; P < .001) and clinics that had somewhat worse implementation (69.0 fewer visits per 1000 patients; P < .001) compared with clinics that had no change in Pi 2 score. There were no associations of change in Pi 2 scores with all-cause hospitalizations or ACSC hospitalizations among patients younger than 65 years. In patients 65 years or older, those seen at clinics that had somewhat worse PCMH implementation experienced fewer ED visits (20.1 fewer visits per 1000 patients; P = .002) and all-cause hospitalizations (12.4 fewer hospitalizations per 1000 patients; P = .007) compared with clinics with no change in Pi 2 score. There was no association between change in Pi 2 score with ACSC hospitalizations among patients 65 years or older. (continued) Key Points Question Is a change in patientcentered medical home implementation associated with changes in high-cost health care utilization in the US Veterans Health Administration health care system? Findings In this cohort study including 1 650 976 veterans, neither improvement nor decline in patientcentered medical home implementation was consistently associated with changes in the numbers of emergency department visits, ambulatory caresensitiv...

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Association between Continuity and Team‐Based Care and Health Care Utilization: An Observational Study of Medicare‐Eligible Veterans in VA Patient Aligned Care Team

Cited by 24 publications

References 30 publications

Dedicated to the Mission: Strategies US Department of Veterans Affairs Home‐Based Primary Care Teams Apply to Keep Veterans at Home

Dedicated to the Mission: Strategies US Department of Veterans Affairs Home‐Based Primary Care Teams Apply to Keep Veterans at Home

HSR Commentary: Linking VA and Non‐VA Data to Address Important US Veteran Health Services Research Issues

Association of High-Cost Health Care Utilization With Longitudinal Changes in Patient-Centered Medical Home Implementation

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