A First Look at PCMH Implementation for Minority Veterans: Room for Improvement.

Hernandez SE, Taylor L, Grembowski D, Reid RJ, Wong E, Nelson KM, Liu CF, Fihn SD, Hebert PL. A First Look at PCMH Implementation for Minority Veterans: Room for Improvement. Medical care. 2016 Mar 1; 54(3):253-61.

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Abstract:

BACKGROUND: Implementation of Patient Aligned Care Teams (PACT), a patient-centered medical home model, has been inconsistent among the > 900 primary care facilities in the Veterans Health Administration. OBJECTIVE: Estimate if the degree of PACT implementation at a facility varied with the percentage of minority veteran patients at the facility. RESEARCH DESIGN: Cross-sectional, facility-level analysis of PACT implementation measures in 2012. SUBJECTS: Veterans Health Administration hospital-based and community-based primary care facilities. MEASURES: We used a previously validated PACT Implementation Progress Index (Pi) and its 8 domains: access, continuity of care, care coordination, comprehensiveness, self-management support, and patient-centered care and communication, shared decision-making domains, and team functioning. Facilities were categorized as low ( < 5.2%, n = 208), medium (5.2%-25.8%, n = 413), and high ( > 25.8%, n = 206) percent minority based on the percent of their own veteran population. RESULTS: Most minority veterans received care in high minority (69%) and medium minority facilities (29%). In adjusted analyses, medium and high minority facilities scored 0.773 (P = 0.009) and 0.930 (P = 0.008) points lower on the Pi score relative to low minority facilities. Relative to low minority facilities, both medium and high minority facilities were less likely of having high Pi scores ( 2) and more likely of having low Pi scores ( -2). Both medium and high minority facilities had the same 3 domain scores lower than low minority facilities (care coordination, comprehensiveness, and self-management). CONCLUSION: Overall PACT implementation varied with respect to the racial/ethnic composition of a facility, with medium and high minority facilities having a lower implementation scores.