Delivering PACT-Principled Care: Are Specialty Care Patients Being Left Behind?

Fix, Gemmae M.; Asch, Steven M.; Saifu, Hemen N; Fletcher, Michael; Gifford, Allen L.; Bokhour, Barbara G.

doi:10.1007/s11606-013-2677-9

Cited by 25 publications

(25 citation statements)

References 31 publications

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“…If single‐system use is better for veterans, VHA may need to consider designing programs or policies that support exclusive VHA utilization for chronic wound care. VHA's Patient‐Aligned Care Teams (PACT), the patient‐centered medical home program that involves team‐based and coordinated care, might be tailored to deliver high quality wound care, for example . Future research should examine whether specific elements of PACT, including those related to coordinated care, are associated with improved wound healing .…”

Section: Discussionmentioning

confidence: 99%

Medicare‐VHA dual use is associated with poorer chronic wound healing

Bouldin

Littman

Wong

et al. 2016

Wound Repair Regeneration

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Veterans who use Veterans Health Affairs (VHA) have the option of enrolling in and obtaining care from other non-VA sources. Dual system use may improve care by increasing options or it may result in poorer outcomes because of fragmented care. Our objective was to assess whether dual system use of VHA and Medicare for wound care was associated with chronic wound healing. We conducted a retrospective cohort study of 227 Medicare-enrolled VHA users in the Pacific Northwest who had an incident, chronic lower limb wound between October 1, 2006 and September 30, 2007 identified through VHA chart review. All wounds were followed until resolution or for up to one year. Dual system wound care was identified through Medicare claims during follow-up. We used a proportional hazards model to compare wound healing among VHA-exclusive and dual wound care users, using a time-varying measure of dual use and treating amputation and death as competing risks. About 18.1% of subjects were classified as dual wound care users during follow-up. After adjustment using propensity scores, dual use was associated with a significantly lower hazard of wound healing compared to VHA-exclusive use (HR = 0.63, 95%CI: 0.39-0.99, p = 0.047). Hazards for the competing risks, amputation (HR = 4.23, 95% CI: 1.61-11.15, p = 0.003) and death (HR = 3.08, 95%CI: 1.11-8.56, p = 0.031), were significantly higher for dual users compared to VHA-exclusive users. Results were similar in inverse probability of treatment weighted analyses and in sensitivity analyses that excluded veterans enrolled in a Medicare managed care plan and that used a revised wound resolution date based on Medicare claims data, but were not always statistically significant. Overall, dual wound care use was associated with substantially poorer wound healing compared to VHA-exclusive wound care use. VHA may need to design programs or policies that support and improve care coordination for veterans needing chronic wound care.

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Section: Discussionmentioning

confidence: 99%

Medicare‐VHA dual use is associated with poorer chronic wound healing

Bouldin

Littman

Wong

et al. 2016

Wound Repair Regeneration

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“…Patients reported an improvement in their perception of the time spent in consultation with the physician in the PCMH model (Kern et al 2013), and a positive correlation was observed in several studies for physician continuity and patient satisfaction in the PCMH (Fishman et al 2012;Takane and Hunt 2012;Day et al 2013;Wagner et al 2015). The importance of the patient-provider relationship was explored in qualitative studies, with a range of positive experiences reported (Takane and Hunt 2012;Fix et al 2014;Aysola et al 2015;Wagner et al 2015). If patients had a positive relationship with their physician, this was seen to be of greater importance than any challenges encountered when accessing care (Aysola et al 2015).…”

Section: Patient-provider Relationshipmentioning

confidence: 96%

“…For studies that described patient experience, one study reported no patient concern relating to care coordination in the PCMH (Aysola et al 2015), whereas other studies had mixed results for care coordination (Fix et al 2014;Wagner et al 2015). Patients reported very positive experiences in the PCMH model for provision of reminders and administration (87 and 93.7% Takane and Hunt (2012) Patient perception of PCMH during transition.…”

Section: Care Coordination and Integrationmentioning

confidence: 99%

Review of patient-reported experience within Patient-Centered Medical Homes: insights for Australian Health Care Homes

O'Loughlin

Mills

McDermott

et al. 2017

Aust. J. Prim. Health

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Abstract. Understanding patient experience is necessary to advance the patient-centred approach to health service delivery. Australia's primary healthcare model, the 'Health Care Home', is based on the 'Patient-Centered Medical Home' (PCMH) model developed in the United States. Both these models aim to improve patient experience; however, the majority of existing PCMH model evaluations have focussed on funding, management and quality assurance measures. This review investigated the scope of evidence reported by adult patients using a PCMH. Using a systematic framework, the review identified 39 studies, sourced from 33 individual datasets, which used both quantitative and qualitative approaches. Patient experience was reported for model attributes, including the patient-physician and patient-practice relationships; carecoordination; access to care; and, patient engagement, goal setting and shared decision-making. Results were mixed, with the patient experience improving under the PCMH model for some attributes, and some studies indicating no difference in patient experience following PCMH implementation. The scope and quality of existing evidence does not demonstrate improvement in adult patient experience when using the PCMH. Better measures to evaluate patient experience in the Australian Health Care Home model are required.Additional keywords: healthcare evaluation, health services research, quality of health care.

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“…The use of EHRs has also been reported to accelerate 'quality improvements and changes in utilisation over time on some measures', 115 again in several countries: Germany, the Netherlands and the USA. Two other characteristics that are shown in several studies to improve patients' experience of care in MCP-like organisations and networks are (1) the use of patient panels to strengthen trust in patient-provider relationships 91,163 and (2) personalised care and support from people working in boundary-spanning roles. 66,164 However, the studies we reviewed generally lacked evidence about how to evaluate, monitor and adjust the overall flow of patients within a MCP equivalent in order to ensure that it can achieve its aims of improving care within tight resources.…”

Section: Patient Experiencementioning

confidence: 99%

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

Sheaff

Brand

Lloyd

et al. 2018

Health Serv Deliv Res

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Background The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets. Objectives To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly. Design Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way. Data sources Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions. Results The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individual patients and the diversion of patients from inpatient to primary care. The evidence was weaker, or mixed (supporting some of the constituent assumptions but not others), concerning voluntary sector involvement, the effects of preventative care on hospital admissions and patient experience, planned referral networks and demand management systems. The evidence about the effects of referral reductions on costs was equivocal. We found no studies confirming that the development of preventative care would reduce demands on inpatient services. The IPT had overlooked certain mechanisms relevant to MCPs, mostly concerning MDTs and the uses of HITs. Limitations The studies reviewed were limited to Organisation for Economic Co-operation and Development countries and, because of the large amount of published material, the period 2014–16, assuming that later studies, especially systematic reviews, already include important earlier findings. No empirical studies of MCPs yet existed. Conclusions Multidisciplinary teams are a central mechanism by which MCPs (and equivalent networks and organisations) work, provided that the teams include the relevant professions (hence, organisations) and, for care planning, individual patients. Further primary research would be required to test elements of the revised logic model, in particular about (1) how MDTs and enhanced general practice compare and interact, or can be combined, in managing referral networks and (2) under what circumstances diverting patients from in-patient to primary care reduces NHS costs and improves the quality of patient experience. Study registration This study is registered as PROSPERO CRD42016038900. Funding The National Institute for Health Research (NIHR) Health Services and Delivery Research programme and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.

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Delivering PACT-Principled Care: Are Specialty Care Patients Being Left Behind?

Cited by 25 publications

References 31 publications

Medicare‐VHA dual use is associated with poorer chronic wound healing

Medicare‐VHA dual use is associated with poorer chronic wound healing

Review of patient-reported experience within Patient-Centered Medical Homes: insights for Australian Health Care Homes

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

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