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

Abstract

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.

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

“…6 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 3,[7][8][9][10][11][12][13][14][15] and better quality. 16,17 However, other research has shown higher costs for HBPC care 14,18 and no significant differences in emergency department visits before or after HBPC enrollment. 18 Some studies identified key factors in successfully implementing the PACT model in traditional clinic-based outpatient primary care settings, 6,17 including PCP continuity, 16 participatory decision making, 6 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.…”

“…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 .…”

“…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.…”

“…18 Some studies identified key factors in successfully implementing the PACT model in traditional clinic-based outpatient primary care settings, 6,17 including PCP continuity, 16 participatory decision making, 6 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. 17 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. We designed this qualitative study by conducting in-person site visits, with the purpose of describing and explaining strategies HBPC teams use to enhance the interdisciplinary patientcentered care they deliver to home-based, frail, older veterans, from HBPC team members' perspectives.…”

Advancing the Science of Implementation in Primary Health Care

“…Sullivan et al 34 describe the implementation of a patient-centered medical home model for older individuals called Geriatric Patient Aligned Care Teams (GeriPACT) in the Veterans' Health Administration. GeriPACT is hypothesized to improve care quality through enhanced care coordination, improved personalized care, and a positive culture of service.…”