Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.
Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94305, USA.
J Gen Intern Med. 2019 May;34(Suppl 1):75-81. doi: 10.1007/s11606-019-04965-0.
Intensive primary care programs aim to coordinate care for patients with medical, behavioral, and social complexity, but little is known about their impact on patient experience when implemented in a medical home.
Determine how augmenting the VA's medical home (Patient Aligned Care Team, PACT) with a PACT-Intensive Management (PIM) program influences patient experiences with care coordination, access, provider relationships, and satisfaction.
Cross-sectional analysis of patient survey data from a five-site randomized quality improvement study.
Two thousand five hundred sixty-six Veterans with hospitalization risk scores ≥ 90th percentile and recent acute care.
PIM offered patients intensive care coordination, including home visits, accompaniment to specialists, acute care follow-up, and case management from a team staffed by primary care providers, social workers, psychologists, nurses, and/or other support staff.
Patient-reported experiences with care coordination (e.g., health goal assessment, test and appointment follow-up, Patient Assessment of Chronic Illness Care (PACIC)), access to healthcare services, provider relationships, and satisfaction.
Seven hundred fifty-nine PIM and 768 PACT patients responded to the survey (response rate 60%). Patients randomized to PIM were more likely than those in PACT to report that they were asked about their health goals (AOR = 1.26; P = 0.046) and that they have a VA provider whom they trust (AOR = 1.35; P = 0.005). PIM patients also had higher mean (SD) PACIC scores compared with PACT patients (2.91 (1.31) vs. 2.75 (1.25), respectively; P = 0.022) and were more likely to report 10 out of 10 on satisfaction with primary care (AOR = 1.25; P = 0.048). However, other effects on coordination, access, and satisfaction did not achieve statistical significance.
Augmenting VA's patient-centered medical home with intensive primary care had a modestly positive influence on high-risk patients' experiences with care coordination and provider relationships, but did not have a significant impact on most patient-reported access and satisfaction measures.
强化初级保健计划旨在协调医疗、行为和社会复杂性患者的护理，但在医疗之家实施时，对患者体验的影响知之甚少。
确定 VA 医疗之家（患者一致护理团队，PACT）中增加 PACT-强化管理（PIM）计划如何影响患者对护理协调、获得医疗服务、医患关系和满意度的体验。
五项随机质量改进研究的患者调查数据的横断面分析。
2566 名风险评分≥第 90 百分位数的退伍军人和最近急性护理。
PIM 为患者提供强化护理协调，包括家访、陪同专科医生就诊、急性护理随访以及由初级保健提供者、社会工作者、心理学家、护士和/或其他支持人员组成的团队提供的病例管理。
患者报告的护理协调体验（例如，健康目标评估、测试和预约跟进、慢性病护理评估（PACIC））、获得医疗服务的机会、医患关系和满意度。
759 名 PIM 和 768 名 PACT 患者对调查做出了回应（回应率 60%）。与 PACT 组相比，随机分配到 PIM 组的患者更有可能报告他们被问到健康目标（优势比 [AOR] = 1.26；P = 0.046）并且他们有一个他们信任的 VA 提供者（AOR = 1.35；P = 0.005）。PIM 患者的 PACIC 评分也高于 PACT 患者（分别为 2.91（1.31）和 2.75（1.25）；P = 0.022），并且更有可能报告对初级保健的满意度为 10 分（AOR = 1.25；P = 0.048）。然而，其他关于协调、获得医疗服务和满意度的影响并没有达到统计学意义。
VA 的以患者为中心的医疗之家增加强化初级保健对高危患者的护理协调和医患关系体验产生了适度的积极影响，但对大多数患者报告的获得医疗服务和满意度措施没有重大影响。
