TY - JOUR
KW - Case Management
KW - Case-Control Studies
KW - Humans
KW - Primary Health Care/methods/standards
KW - Program Development/methods
KW - Quality Improvement
KW - Transitional Care/trends
KW - United States
KW - United States Department of Veterans Affairs/organization & administration/trends
KW - Veterans/statistics & numerical data
KW - Care management
KW - Complex patients
KW - primary care redesign
KW - Veterans
AU - E. T. Chang
AU - P. V. Raja
AU - S. E. Stockdale
AU - M. L. Katz
AU - D. M. Zulman
AU - J. A. Eng
AU - K. H. Hedrick
AU - J. L. Jackson
AU - N. Pathak
AU - B. Watts
AU - C. Patton
AU - G. Schectman
AU - S. M. Asch
A1 - 
AB - Many integrated health systems and accountable care organizations have turned to intensive primary care programs to improve quality of care and reduce costs for high-need high-cost patients. How best to implement such programs remains an active area of discussion. In 2014, the Veterans Health Administration (VHA) implemented five distinct intensive primary care programs as part of a demonstration project that targeted Veterans at the highest risk for hospitalization. We found that programs evolved over time, eventually converging on the implementation of the following elements: 1) an interdisciplinary care team, 2) chronic disease management, 3) comprehensive patient assessment and evaluation, 4) care and case management, 5) transitional care support, 6) preventive home visits, 7) pharmaceutical services, 8) chronic disease self-management, 9) caregiver support services, 10) health coaching, and 11) advanced care planning. The teams also found that including social workers and mental health providers on the interdisciplinary teams was critical to effectively address psychosocial needs of these complex patients. Having a central implementation coordinator facilitated the convergence of these program features across diverse demonstration sites. In future iterations of these programs, VHA intends to standardize staffing and key features to develop a scalable program that can be disseminated throughout the system.
AD - Department of General Internal Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; Department of Medicine, University of California at Los Angeles, Los Angeles, CA, United States; VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, United States. Electronic address: Evelyn.Chang@va.gov.; Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States. Electronic address: praja@mednet.ucla.edu.; VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, CA, United States. Electronic address: Susan.Stockdale@va.gov.; VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, United States. Electronic address: Marian.Katz@va.gov.; VA Center for Innovation to Implementation (Ci2i), Menlo Park, CA, USA; Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, United States. Electronic address: dzulman@stanford.edu.; Geriatrics, Palliative, and Extended Care Service line, San Francisco VA Medical Center, San Francisco, CA, United States; Division of Geriatrics, University of California San Francisco, San Francisco, CA, United States. Electronic address: Jessica.Eng@va.gov.; W.G. (Bill) Hefner VA Medical Center, Salisbury, NC, United States. Electronic address: Kathy.Hedrick@va.gov.; Department of Medicine, Zablocki VA Medical Center, Milwaukee, WI, United States; Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States. Electronic address: Jeffrey.Jackson6@va.gov.; Department of Medicine, Atlanta VA Medical Center, Atlanta, GA, United States; Department of Medicine, Emory University, Atlanta, GA, United States. Electronic address: Neha.Pathak@va.gov.; Louis Stokes Clevel(TRUNCATED)
BT - Healthcare (Amsterdam, Netherlands)
C5 - Financing & Sustainability; Healthcare Disparities
CP - 4
CY - Netherlands
IS - 4
JF - Healthcare (Amsterdam, Netherlands)
M1 - Journal Article
N2 - Many integrated health systems and accountable care organizations have turned to intensive primary care programs to improve quality of care and reduce costs for high-need high-cost patients. How best to implement such programs remains an active area of discussion. In 2014, the Veterans Health Administration (VHA) implemented five distinct intensive primary care programs as part of a demonstration project that targeted Veterans at the highest risk for hospitalization. We found that programs evolved over time, eventually converging on the implementation of the following elements: 1) an interdisciplinary care team, 2) chronic disease management, 3) comprehensive patient assessment and evaluation, 4) care and case management, 5) transitional care support, 6) preventive home visits, 7) pharmaceutical services, 8) chronic disease self-management, 9) caregiver support services, 10) health coaching, and 11) advanced care planning. The teams also found that including social workers and mental health providers on the interdisciplinary teams was critical to effectively address psychosocial needs of these complex patients. Having a central implementation coordinator facilitated the convergence of these program features across diverse demonstration sites. In future iterations of these programs, VHA intends to standardize staffing and key features to develop a scalable program that can be disseminated throughout the system.
PP - Netherlands
PY - 2018
SN - 2213-0772; 2213-0764
SP - 231
EP - 237
EP - 
T1 - What are the key elements for implementing intensive primary care? A multisite Veterans Health Administration case study
T2 - Healthcare (Amsterdam, Netherlands)
TI - What are the key elements for implementing intensive primary care? A multisite Veterans Health Administration case study
U1 - Financing & Sustainability; Healthcare Disparities
U2 - 29102480
VL - 6
VO - 2213-0772; 2213-0764
Y1 - 2018
Y2 - Dec
ER -