December 2020

In This Issue: Enhancing Primary Care for Veterans with Chronic Illness
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Quality of Care and Patient Experience in GeriPACT: Specialty Primary Care for Elderly Veterans

Feature Article

Takeaway: This study will help determine how quality and experience of care differ when a VA patient moves from usual care, in PACT, to GeriPACT. The study will also help decision-makers guide appropriate resources toward GeriPACT – and inform decisions about the type of patients who will benefit most from GeriPACT care.

A Geriatric Patient Aligned Care Team (GeriPACT) integrates and coordinates traditional ambulatory healthcare services with a variety of community-based services to optimize independence, quality of life, and care for older Veterans. Currently, there is a lack of essential information about how GeriPACT differs from traditional PACT care in terms of clinical processes and patient experience of care, specifically what types of patients may benefit most from this limited resource.

The main objective of this ongoing HSR&D study (July 2017 – June 2021) is to understand the impact of GeriPACT on patient experience and key quality of care clinical process measures that might contribute to observed cost differences. In addition, investigators will evaluate three important sub-populations, Veterans with: 1) cognitive impairment, 2) functional disability, and 3) multiple chronic conditions. Using targeted recruiting strategies to increase homogeneity between GeriPACT and PACT patients, investigators are assessing changes between GeriPACT (n=275) and PACT patients (n=275) from VA medical centers that offer established GeriPACTs. More specifically, this matched comparative effectiveness study is examining:

• The quality of care among Veterans who transfer care to GeriPACT, compared to similar patients in traditional PACTs;
• Patient experience of care among Veterans who transfer care to GeriPACT, compared to similar patients in traditional PACTs; and,
• Whether the relationship between GeriPACT exposure and outcomes differs based on cognitive status, functional disability, or multiple chronic conditions.

Investigators are conducting telephone interviews at baseline and at three subsequent time points (6, 12, and 18 months). The primary outcome (days at home) is measured from administrative data over the full 18-month outcome study period. This timeline allows for the clinical gains in days at home from GeriPACT to accrue before they would expect an impact on unique types of utilization such as emergency department care or inpatient care. Other outcomes will be measured over six-month intervals for 18 months because they expect them to be sensitive, both in the short- and the longer-term, to the GeriPACT model of care.

Findings

For this study, 275 matched pairs were recruited in near real-time, with a median time of 7 days between enrolling a GeriPACT patient and a closely matched PACT patient. This design harnesses the power of national administrative data coupled with collection of patient-reported outcomes, enabling rigorous evaluation of non-randomized programs or policies. Findings on patient experience of care and quality of care will be forthcoming.

Impact

This study will help determine how quality and experience of care differ when a VA patient moves from usual care, in PACT, to GeriPACT. The study will also help decision-makers guide appropriate resources towards GeriPACT – and inform decisions about the type of patients who will benefit most from GeriPACT care.

Principal Investigator: S. Nicole (Nicki) Hastings, MD, MHSc, is Director of HSR&D’s Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), and Courtney Van Houtven, PhD, leads ADAPT’s Function and Independence Research Unit, Durham VA Health Care System in Durham, NC.

Publications

None at this time.

View study abstract