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Research ArticleOriginal Research

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

Jennifer L. Sullivan, Rina Eisenstein, Thomas Price, Samantha Solimeo and Kenneth Shay
The Journal of the American Board of Family Medicine May 2018, 31 (3) 456-465; DOI: https://doi.org/10.3122/jabfm.2018.03.170272
Jennifer L. Sullivan
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System (JLS); 2Boston University School of Public Health, Boston, MA (JLS); Atlanta Veterans Affairs Medical Center, Atlanta, GA (RE, TP); Section of Geriatric Medicine and Gerontology, Emory University School of Medicine, Atlanta (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); 7 US Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, D.C. (KS).
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Rina Eisenstein
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System (JLS); 2Boston University School of Public Health, Boston, MA (JLS); Atlanta Veterans Affairs Medical Center, Atlanta, GA (RE, TP); Section of Geriatric Medicine and Gerontology, Emory University School of Medicine, Atlanta (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); 7 US Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, D.C. (KS).
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Thomas Price
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System (JLS); 2Boston University School of Public Health, Boston, MA (JLS); Atlanta Veterans Affairs Medical Center, Atlanta, GA (RE, TP); Section of Geriatric Medicine and Gerontology, Emory University School of Medicine, Atlanta (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); 7 US Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, D.C. (KS).
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Samantha Solimeo
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System (JLS); 2Boston University School of Public Health, Boston, MA (JLS); Atlanta Veterans Affairs Medical Center, Atlanta, GA (RE, TP); Section of Geriatric Medicine and Gerontology, Emory University School of Medicine, Atlanta (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); 7 US Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, D.C. (KS).
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Kenneth Shay
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System (JLS); 2Boston University School of Public Health, Boston, MA (JLS); Atlanta Veterans Affairs Medical Center, Atlanta, GA (RE, TP); Section of Geriatric Medicine and Gerontology, Emory University School of Medicine, Atlanta (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); 7 US Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, D.C. (KS).
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Article Figures & Data

Tables

    • View popup
    Table 1.

    Team Member Composition (N = 44)

    Team Role: CoreN
    Social worker37
    Registered nurse33
    Physician/geriatrician32
    Clerical associate25
    Licensed practical nurse24
    Pharmacist/clinical pharmacist specialist23
    Team Role: ExtendedN
    Dietician14
    Psychologist/geropsychologist14
    Nurse practitioner12
    Other unspecified7
    Speech or language pathologist4
    Clinical registered nurse specialist3
    Physician assistant2
    Health administrator2
    Occupational therapist2
    Physical therapist2
    Nurse aide1
    Chaplain1
    • View popup
    Table 2.

    Distribution of Geriatric Patient-Aligned Care Team Member Full-Time Employment Equivalent

    Team Role: CoreMean FTEESDMinMaxN
    Physician/geriatrician0.730.390.081.5033
    Registered nurse0.710.330.071.0029
    Licensed practical nurse0.750.450.082.0019
    Clerical associate0.560.3401.0023
    Social worker0.430.3501.0032
    Pharmacist/clinical pharmacist specialist0.350.320.011.0026
    Team Role: ExtendedMean FTEESDMinMaxN
    Nurse aide1.00-1.001.001
    Nurse practitioner0.770.4802.0017
    Clinical resident nurse Specialist0.590.370.301.003
    Physician assistant0.500.4101.004
    Occupational therapist0.380.4801.004
    Physical therapist0.380.4801.003
    Health administrator0.310.090.250.382
    Psychologist/geropsychologist0.260.2901.0012
    Dietician0.240.3001.009
    Psychiatrist/geropsychiatrist0.200.2601.0012
    Speech or language pathologist0.080.1400.253
    • FTEE, full-time employment equivalents; SD, standard deviation.

    • View popup
    Table 3.

    Most Commonly Reported Patient-Aligned Care Team Practices Used in Geriatric Patient-Aligned Care Team (N = 36)

    N
    Access and Scheduling (average practices implemented = 6.89/10)
    provides non-face-to-face clinical guidance to patients36
    schedules each patient with a personal clinician except when the clinician is unavailable35
    provides a same-day appointment if clinically indicated, excluding emergency department31
    Care Coordination (average practices implemented = 17.9/22)
    reviews information received from other facilities to identify what follow-up support a patient needs36
    assesses barriers when patients do not move toward their treatment goals (eg, medication adherence, costs of care, and lack of family support).35
    incorporates external records into the practice chart35
    reviews charts in advance of visits to anticipate patient needs34
    Population Management (average practices implemented = 8.05/13)
    incorporates evidence-based guidelines into everyday workflows for important conditions seen by Geriatric Patient-Aligned Care Team32
    identifies patient on particular medications who need monitoring or evaluation and reminds them of this need28
    identifies patient who might benefit from additional coordination/care management services and contacts them about these options27
    Care Processes (average practices implemented = 11.38/20)
    involves patients in their own decision making36
    offers patients information about Advance Directives36
    routinely determined whether a patient has difficulty with hearing, vision, or other barriers to communication35
    provides a list of agencies, community-based organizations, or other entities to patients/families that support patient self-management (when appropriate).28
    Quality Improvement (average practices implemented = 9.69/19)
    measure or receive data on the performance of the practice on key clinical and administrative processes27
    Organizational Elements (average practices implemented = 9.36/14)
    works as a team36
    notifies patients of all abnormal results36
    manages findings of lab tests and imaging procedures34
    • View popup
    Table 4.

    Least Commonly Reported Patient-Aligned Care Team Practices Used in Geriatric Patient-Aligned Care Team (N = 36)

    N
    Access and Scheduling
    schedules group visits for some populations of patients5
    schedules dedicated “phone hours” when patients know that they can reach their clinician8
    Care Coordination
    establishes communication processes and expectations for notifications of admissions with local hospitals and emergency departments15
    provides a written case summary and transition plan for patients transitioning care to another clinician/facility17
    Population Management
    generates lists of patients who need attention through the use of electronic information14
    incorporates the guidance of clinical guidelines into flow sheets, standing orders, training, and other every-day processes to facilitate adherence to the clinical guidelines15
    Care Processes
    has a committee of patients to advise the facility6
    involves patients/families in developing information and education materials for GeriPACT9
    involves patients/families in facilitating programs and group activities for other patients/families10
    Quality Improvement
    data on wait or turnaround times for lab tests, phone calls, or other service-level activities are collected8
    data on the confidence patients have in their clinicians and GeriPACT are collected11
    data on medication errors and other safety events are collected12
    Healthcare Effectiveness Data and Information Set measures are reviewed17
    Organizational elements
    has ways to reward members of the team based on collective performance of GeriPACT6
    tracks routine referrals for consultation until a report is received by GeriPACT16
    monitors team performance on key administrative metrics17
    • GeriPACT, Geriatric Patient-Aligned Care Team.

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The Journal of the American Board of Family     Medicine: 31 (3)
The Journal of the American Board of Family Medicine
Vol. 31, Issue 3
May-June 2018
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Implementation of the Geriatric Patient-Aligned Care Team Model in the Veterans Health Administration (VA)
Jennifer L. Sullivan, Rina Eisenstein, Thomas Price, Samantha Solimeo, Kenneth Shay
The Journal of the American Board of Family Medicine May 2018, 31 (3) 456-465; DOI: 10.3122/jabfm.2018.03.170272

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Implementation of the Geriatric Patient-Aligned Care Team Model in the Veterans Health Administration (VA)
Jennifer L. Sullivan, Rina Eisenstein, Thomas Price, Samantha Solimeo, Kenneth Shay
The Journal of the American Board of Family Medicine May 2018, 31 (3) 456-465; DOI: 10.3122/jabfm.2018.03.170272
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