QUERI – Quality Enhancement Research Initiative

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Advancing Healthcare Innovation: A Partnered-Evaluation of Geriatric Patient-Aligned Care Team (GeriPACT) Implementation

Boston, MA and Iowa City, IA

Overview:

The Geriatric Patient Aligned Care Team (GeriPACT) model offers an alternative to standard Patient-Aligned Care Teams (PACTs) by providing frail, elderly Veterans and their caregivers with access to the most appropriate care for their healthcare needs with a single point-of-contact for multidisciplinary Geriatric Care. To date, at least 74 VA medical centers (VAMCs) have implemented the GeriPACT model with at least 20 VAMCs coming on-board in FY16. Preliminary data provided by the Office of Geriatrics and Extended Care (GEC) suggest that the cost of managing patients in GeriPACTs is lower compared to traditional PACTs. However, GeriPACT has not been thoroughly studied and little is known about how GeriPACTs are structured, how variations in programs across VAMCs influence the care that Veterans receive, or whether GeriPACTs improve the patient and provider experience.

Objectives:

The primary objective of this partnered-evaluation is to conduct an observational mixed-methods assessment of GeriPACT implementation to support rapid translation of the findings into practice. Specific aims include:

  • Assess GeriPACT implementation adherence and service outcomes;
  • Examine the relationship of implementation adherence, service, and patient utilization and GeriPACT costs;
  • Compare utilization and cost outcomes for similar GeriPACT and PACT patients over time; and
  • Identify important organizational contextual factors associated with GeriPACT performance by conducting an in-depth evaluation at eight VAMCs with high GeriPACT adherence, but that vary on other service outcomes directly related to GeriPACT performance.

Methodology:

Investigators will measure implementation adherence and service outcomes by conducting surveys of GeriPACT leaders and the GeriPACT team. They also will examine the relationship of implementation and service outcomes with patient outcomes for FY15-16. Since GeriPACT is an alternative to PACT, they will compare outcomes for Veterans between these care settings using FY12-16 secondary data. They will conduct eight in-depth sites visits at VAMCs with high GeriPACT implementation adherence, yet with variation in service outcomes. In addition, they will identify key organizational contextual factors distinguishing VAMCs with a high number of PACT features in GeriPACT and high PACT access from other VAMCs, where the number of PACT features in GeriPACT and access to PACT is lower in both domains.

Operations Partner(s):

The Office of Geriatrics and Extended Care (GEC) is the partner for this project, and the evaluation of GeriPACT implementation involves substantial support from the GEC Data and Analyses Center (GEC DAC), led by GEC DAC co-Principal Investigator, Orna Intrator, PhD.

Principal Investigator: Jennifer Sullivan, PhD, Center for Healthcare Organization and Implementation Research (CHOIR); contact at jennifer.sullivan@va.gov .