Open Access in the Patient-Centered Medical Home: Lessons from the Veterans Health Administration

Teamwork and Delegation in Medical Homes: Primary Care Staff Perspectives in the Veterans Health Administration

“…26,27 Striking similarities in our findings, despite significant geographic variation across sites, led to cross-Lab conversations about the conditions necessary to form and support effective, engaged teams in medical homes. Accordingly, we conducted a joint analysis of interview data to identify resources that help frontline primary care staff function as teams.…”

“…Both Labs are conducting a mixed-methods practical formative evaluation 28 to understand factors affecting variation in implementation, as well as experiences and perspectives of frontline primary care staff. 26,27 Within the practical formative evaluation framework, each Lab employs a variety of individual methods, including observational site visits, review of internal organizational documents, interview techniques, and feedback mechanisms. 28 Details of the overall study design for both Labs are described elsewhere.…”

“…28 Details of the overall study design for both Labs are described elsewhere. 26,27 Methodological similarities enable a collaborative, joint analysis of parallel qualitative data across the two Labs in order to demonstrate transferability of findings and to develop a broad, comprehensive understanding of the challenges facing PACTs nationally.…”

Challenges Facing Primary Care Practices Aiming to Implement Patient-Centered Medical Homes

“…Not surprisingly, pilot teams for PACT have given particular emphasis on improving access. 36 Substantial gains in VA preventive care delivery predated VA's PACT initiative, 21 reflecting prior investments in PC, at least in part. 37 We were therefore not entirely surprised that VA PC directors reported the least amount of frustration with preventive care delivery, and even then, only with CRC screening, which requires iterative steps and specialty collaboration.…”

Panel Management to Improve Smoking and Hypertension Outcomes by VA Primary Care Teams: A Cluster-Randomized Controlled Trial

“…Early analysis of the PACT demonstration sites revealed challenges in accessing accurate and actionable patient data and insufficient time for such efforts. 13 Thus, there is a pressing need to develop and test panel management strategies, including whether additional education is needed or simply having staff resources is sufficient to improve panel health.…”