Table 4.

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

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.