1130 — What are the Most Used and Most Helpful Facilitators for Implementation of a Patient-Centered Medical Home?

Gale RC, Veterans Health Administration; Asch SM, Veterans Health Administration; Taylor T, Veterans Health Administration; Nelson KM, Veterans Health Administration; Luck J, Oregon State University; Meredith LS, RAND Corporation; Helfrich CD, Veterans Health Administration;

Objectives:
Identifying strategies to optimize implementation of patient-centered medical homes (PCMH) is a challenge faced by many health care delivery systems. The Veterans Health Administration (VHA) developed and disseminated a variety of resources to support implementation of its PCMH (the Patient Aligned Care Teams or PACT). We explored which implementation resources PACT personnel used, which they found helpful, and what respondent characteristics were associated with resource use.

Methods:
Analysis of a cross-sectional VHA employee survey fielded during the summer of 2012. Key outcomes were resource use and resource helpfulness. Maximum-likelihood logistic mixed methods were used to predict likelihood of respondents using each resource and rating resources as somewhat/very helpful. Covariates included: PACT team role; years working in primary care; tenure; ethnicity; age; sex; supervisory role; percent of time spent working in Primary Care; PACT teamlet (comprised of providers, RNs, and LPNs) membership.

Results:
Teamlet huddles were the most frequently used resources (80.4 percent used); quality improvement methods to conduct small tests of change were the least frequently used (42.4 percent used). Huddles were rated as the most helpful resources (90.4 percent rated as helpful); new approaches to scheduling were least helpful (72.2 percent rated as helpful). Respondent characteristics most strongly associated with resource use were having supervisory responsibilities (OR: 1.46 to 1.86) and being assigned to a "teamlet" (non-PACT teamlet members OR: 0.17 to 0.78). Relative to primary care providers, RN care managers were more likely to report use (OR: 1.23 to 2.14). Longer VHA tenure was also associated with higher helpfulness ratings.

Implications:
The most used and most helpful resources created time and space for PACT teams to meet and coordinate. Teamlet huddles were the most frequently used and liked resources while QI methods to conduct small tests of change, though often promoted in PCMH models, were least frequently used and liked.

Impacts:
Our data support targeted outreach to those less invested in the system adopting the innovation, such as those with shorter tenure or in supporting roles. These methods may be a useful model for policymakers and systems redesign staff charged with setting priorities for the design and dissemination of complex initiatives.