VA Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA, USA; Department of General Internal Medicine, UCSF School of Medicine, San Francisco, CA, USA.
Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA; Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Healthc (Amst). 2020 Jun;8(2):100429. doi: 10.1016/j.hjdsi.2020.100429. Epub 2020 May 11.
Patient-centered medical home models such as the Veterans Health Administration (VHA) Patient Aligned Care Team (PACT) model aim to improve primary care through accessible, comprehensive, continuous team-based care. Practices that adhere to patient-centered medical home principles have been found to exhibit higher patient satisfaction, possibly leading to higher retention of patients longitudinally and reducing attrition from care. We examined whether greater PACT implementation was related to lower attrition from VHA primary care.
A national cohort of 1.5 million nonelderly patients with chronic conditions and using VHA primary care in the baseline year (fiscal year 2015) was identified. Attrition was measured as not receiving primary care over two subsequent years. PACT implementation in 863 VHA primary care practices was measured by the PACT Implementation Progress Index (Pi2) across 8 domains.
Overall, the attrition rate was 4.4%. Predicted attrition was highest for patients treated in practices with the lowest PACT implementation scores (4.8%) compared to 4.0% among patients in practices with the highest PACT implementation scores (difference = -0.8 (95% CI: -1.3, -0.2)). Better performance on most PACT domains was significantly associated with lower attrition.
Primary care practices that facilitate easier access to providers as well as provide more seamless care coordination, better communication with providers, and support for self-management appear to positively affect patients' decisions to stay in VHA care.
Provision of accessible, comprehensive, team-based primary care, as measured in this study, is likely to be a determinant of patient retention in VHA care.
以退伍军人事务部（VHA）患者为中心的医疗团队（PACT）模式为代表的以患者为中心的医疗之家模式旨在通过可及、全面、持续的团队式护理来改善初级保健。坚持以患者为中心的医疗之家原则的实践已被发现能提高患者满意度，这可能导致患者长期保留率更高，减少护理流失。我们研究了更多的 PACT 实施是否与退伍军人事务部初级保健的流失率降低有关。
确定了一个由 150 万患有慢性病且在基线年（2015 财年）使用退伍军人事务部初级保健的非老年患者组成的全国队列。流失率的衡量标准是在接下来的两年内没有接受初级保健。863 个退伍军人事务部初级保健实践中的 PACT 实施情况通过 8 个领域的 PACT 实施进展指数（Pi2）进行衡量。
总体而言，流失率为 4.4%。在实施 PACT 得分最低的实践中接受治疗的患者（4.8%）的预测流失率最高，而在实施 PACT 得分最高的实践中（4.0%）的患者（差异为-0.8（95%CI：-1.3，-0.2））。在大多数 PACT 领域的表现更好与流失率降低显著相关。
促进更容易获得提供者以及提供更无缝的护理协调、更好的与提供者沟通以及支持自我管理的初级保健实践似乎会对患者决定留在退伍军人事务部护理中产生积极影响。
在这项研究中，提供可及、全面、以团队为基础的初级保健可能是退伍军人事务部护理中患者保留率的决定因素。
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