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Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans.
Implement Sci. 2016 07 19; 11(1):101.IS

Abstract

BACKGROUND

The Veterans Health Administration (VA) has undertaken a major initiative to transform care through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home (PCMH) concept, PACT aims to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient-driven and patient-centered. However, how VA should adapt PACT to meet the needs of special populations, such as women Veterans (WVs), was not considered in initial implementation guidance. WVs' numerical minority in VA healthcare settings (approximately 7-8 % of users) creates logistical challenges to delivering gender-sensitive comprehensive care. The main goal of this study is to test an evidence-based quality improvement approach (EBQI) to tailoring PACT to meet the needs of WVs, incorporating comprehensive primary care services and gender-specific care in gender-sensitive environments, thereby accelerating achievement of PACT tenets for women (Women's Health (WH)-PACT).

METHODS/DESIGN

EBQI is a systematic approach to developing a multilevel research-clinical partnership that engages senior organizational leaders and local quality improvement (QI) teams in adapting and implementing new care models in the context of prior evidence and local practice conditions, with researchers providing technical support, formative feedback, and practice facilitation. In a 12-site cluster randomized trial, we will evaluate WH-PACT model achievement using patient, provider, staff, and practice surveys, in addition to analyses of secondary administrative and chart-based data. We will explore impacts of receipt of WH-PACT care on quality of chronic disease care and prevention, health status, patient satisfaction and experience of care, provider experience, utilization, and costs. Using mixed methods, we will assess pre-post practice contexts; document EBQI activities undertaken in participating facilities and their relationship to provider/staff and team actions/attitudes; document WH-PACT implementation; and examine barriers/facilitators to EBQI-supported WH-PACT implementation through a combination of semi-structured interviews and monthly formative progress narratives and administrative data.

DISCUSSION

Lack of gender-sensitive comprehensive care has demonstrated consequences for the technical quality and ratings of care among WVs and may contribute to decisions to continue use or seek care elsewhere under the US Affordable Care Act. We hypothesize that tailoring PACT implementation through EBQI may improve the experience and quality of care at many levels.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02039856.

Links

PMC Free PDF

Authors+Show Affiliations

Yano EM
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25 (Mailcode 152), Sepulveda, CA, 91343, USA. Elizabeth.yano@va.gov. Department of Health Policy & Management, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Center for Health Sciences, Los Angeles, CA, 90095-1772, USA. Elizabeth.yano@va.gov.
Darling JE
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25 (Mailcode 152), Sepulveda, CA, 91343, USA. Dornsife Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089, USA.
Hamilton AB
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25 (Mailcode 152), Sepulveda, CA, 91343, USA. Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.
Canelo I
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25 (Mailcode 152), Sepulveda, CA, 91343, USA.
Chuang E
Department of Health Policy & Management, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Center for Health Sciences, Los Angeles, CA, 90095-1772, USA.
Meredith LS
RAND Health, 1776 Main Street, Santa Monica, CA, 90401-3208, USA.
Rubenstein LV
VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25 (Mailcode 152), Sepulveda, CA, 91343, USA. RAND Health, 1776 Main Street, Santa Monica, CA, 90401-3208, USA. Department of Medicine, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA, 90073, USA. Department of Medicine, UCLA Geffen School of Medicine, 611 Charles E. Young Drive East, Los Angeles, CA, 90095, USA.

MeSH

Cluster AnalysisEvidence-Based MedicineFemaleHumansPatient Care TeamQuality ImprovementUnited StatesUnited States Department of Veterans AffairsVeteransVeterans Health

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

27435723

Clinical Trial Links

Clinical trial which this article describes

Citation

Yano, Elizabeth M., et al. "Cluster Randomized Trial of a Multilevel Evidence-based Quality Improvement Approach to Tailoring VA Patient Aligned Care Teams to the Needs of Women Veterans." Implementation Science : IS, vol. 11, no. 1, 2016, p. 101.
Yano EM, Darling JE, Hamilton AB, et al. Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans. Implement Sci. 2016;11(1):101.
Yano, E. M., Darling, J. E., Hamilton, A. B., Canelo, I., Chuang, E., Meredith, L. S., & Rubenstein, L. V. (2016). Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans. Implementation Science : IS, 11(1), 101. https://doi.org/10.1186/s13012-016-0461-z
Yano EM, et al. Cluster Randomized Trial of a Multilevel Evidence-based Quality Improvement Approach to Tailoring VA Patient Aligned Care Teams to the Needs of Women Veterans. Implement Sci. 2016 07 19;11(1):101. PubMed PMID: 27435723.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans. AU - Yano,Elizabeth M, AU - Darling,Jill E, AU - Hamilton,Alison B, AU - Canelo,Ismelda, AU - Chuang,Emmeline, AU - Meredith,Lisa S, AU - Rubenstein,Lisa V, Y1 - 2016/07/19/ PY - 2016/06/01/received PY - 2016/06/24/accepted PY - 2016/7/21/entrez PY - 2016/7/21/pubmed PY - 2017/12/5/medline KW - Evidence-based quality improvement KW - Implementation KW - Patient-centered medical home KW - Veterans KW - Women’s health SP - 101 EP - 101 JF - Implementation science : IS JO - Implement Sci VL - 11 IS - 1 N2 - BACKGROUND: The Veterans Health Administration (VA) has undertaken a major initiative to transform care through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home (PCMH) concept, PACT aims to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient-driven and patient-centered. However, how VA should adapt PACT to meet the needs of special populations, such as women Veterans (WVs), was not considered in initial implementation guidance. WVs' numerical minority in VA healthcare settings (approximately 7-8 % of users) creates logistical challenges to delivering gender-sensitive comprehensive care. The main goal of this study is to test an evidence-based quality improvement approach (EBQI) to tailoring PACT to meet the needs of WVs, incorporating comprehensive primary care services and gender-specific care in gender-sensitive environments, thereby accelerating achievement of PACT tenets for women (Women's Health (WH)-PACT). METHODS/DESIGN: EBQI is a systematic approach to developing a multilevel research-clinical partnership that engages senior organizational leaders and local quality improvement (QI) teams in adapting and implementing new care models in the context of prior evidence and local practice conditions, with researchers providing technical support, formative feedback, and practice facilitation. In a 12-site cluster randomized trial, we will evaluate WH-PACT model achievement using patient, provider, staff, and practice surveys, in addition to analyses of secondary administrative and chart-based data. We will explore impacts of receipt of WH-PACT care on quality of chronic disease care and prevention, health status, patient satisfaction and experience of care, provider experience, utilization, and costs. Using mixed methods, we will assess pre-post practice contexts; document EBQI activities undertaken in participating facilities and their relationship to provider/staff and team actions/attitudes; document WH-PACT implementation; and examine barriers/facilitators to EBQI-supported WH-PACT implementation through a combination of semi-structured interviews and monthly formative progress narratives and administrative data. DISCUSSION: Lack of gender-sensitive comprehensive care has demonstrated consequences for the technical quality and ratings of care among WVs and may contribute to decisions to continue use or seek care elsewhere under the US Affordable Care Act. We hypothesize that tailoring PACT implementation through EBQI may improve the experience and quality of care at many levels. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02039856. SN - 1748-5908 UR - https://www.unboundmedicine.com/medline/citation/27435723/Cluster_randomized_trial_of_a_multilevel_evidence_based_quality_improvement_approach_to_tailoring_VA_Patient_Aligned_Care_Teams_to_the_needs_of_women_Veterans_ DB - PRIME DP - Unbound Medicine ER -