QUERI – Quality Enhancement Research Initiative

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Effects of Intensive Outpatient Management Programs on Medication-Related Outcomes for High-Risk Patients

Palo Alto, CA

Overview:

The Patient Aligned Care Team (PACT) is a team-based model of care—based on the Patient Centered Medical Home model—in which a team of VA primary care providers and staff works collaboratively with the patient to provide access to appropriate care for Veterans and coordinate care with other providers, as needed. PACT Intensive Management (PIM) targets Veterans at highest risk for hospital admission and death in primary care, including those with complex chronic conditions. To best help this vulnerable patient population, PIM includes comprehensive needs assessment, coordination of specialty care, chronic condition management, home visits, provision of mental health and social services, rapid response to deteriorations in health, and facilitation of transitions after high-acuity events.

The newly funded Effects of Intensive Outpatient Management Programs on Medication Related Outcomes for High-Risk Patients Partnered Evaluation Initiative seeks to understand whether PACT Intensive Management increased adherence and resolution of medication problems, which represent key pathways to better management of chronic conditions, including improved health status and lower healthcare costs over the long term. Results of this study will be provided to VA policymakers to aid in the planning of care models that can improve the management of high-risk VA patients. Specific research objectives are to:

  • Compare medication adherence for patients taking prescription drugs for diabetes, depression, hyperlipidemia, or hypertension 12 months prior to and 12 months following random allocation to PACT Intensive Management (PIM) or Patient Aligned Care Team (PACT).
  • Assess patients as having the total number of their medications reduced, unchanged, or increased after PIM/PACT allocation. Also, estimate the changes in patients’ lab values and vital status measures for diabetes, hyperlipidemia, and hypertension 12 months prior to and 12 months following allocation to PIM or PACT.
  • Based on interviews with patients and PIM providers, this study will describe patients' barriers and facilitators to medication adherence—and how PIM may have contributed toward their long-term management of medications.

Methodology:

In close collaboration with operation partners, this QUERI Partnered Evaluation Initiative will use both quantitative and qualitative methods to examine effective medication management, including:

  • Interviews with PIM teams and patients to determine barriers to patients’ adherence and other medication management challenges – and the activities performed by PIM teams to address these challenges.
  • Analysis of prescription refill records to determine changes in adherence and medication adjustments after the PIM intervention.

Anticipated Impacts:

In complex, high-risk populations, medication management issues are common. Therefore, robust evidence is needed from data such as these to support VA Office of Primary Care Operations' and Pharmacy Benefits Management's national priorities for optimal and cost-effective care of high-risk patients in the VA healthcare system. Project results will guide further program development around models of care for high-risk patients and toolkits for best practices for national dissemination.

Operations Partner(s):

VA Primary Care Services and Pharmacy Benefits Management Services

Principal Investigator: Jean Yoon, PhD, MHS; contact at Jean.Yoon@va.gov .