A patient-centered primary care practice approach using evidence-based quality improvement

Rationale, methods, and early assessment of implementation

Lisa V. Rubenstein*, Susan E. Stockdale, Negar Sapir, Lisa Altman, Timothy Dresselhaus, Susanne Salem-Schatz, Susan Vivell, John Ovretveit, Alison B. Hamilton, Elizabeth M. Yano

*Corresponding author for this work

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

BACKGROUND: Healthcare systems and their primary care practices are redesigning to achieve goals identified in Patient-Centered Medical Home (PCMH) models such as Veterans Affairs (VA)'s Patient Aligned Care Teams (PACT). Implementation of these models, however, requires major transformation. Evidence-Based Quality Improvement (EBQI) is a multi-level approach for supporting organizational change and innovation spread. OBJECTIVE: To describe EBQI as an approach for promoting VA's PACT and to assess initial implementation of planned EBQI elements. DESIGN: Descriptive. PARTICIPANTS: Regional and local interdisciplinary clinical leaders, patient representatives, Quality Council Coordinators, practicing primary care clinicians and staff, and researchers from six demonstration site practices in three local healthcare systems in one VA region. INTERVENTION: EBQI promotes bottom-up local innovation and spread within top-down organizational priorities. EBQI innovations are supported by a research-clinical partnership, use continuous quality improvement methods, and are developed in regional demonstration sites. APPROACH: We developed a logic model for EBQI for PACT (EBQI-PACT) with inputs, outputs, and expected outcomes. We describe implementation of logic model outputs over 18 months, using qualitative data from 84 key stakeholders (104 interviews from two waves) and review of study documents. RESULTS: Nearly all implementation elements of the EBQI-PACT logic model were fully or partially implemented. Elements not fully achieved included patient engagement in Quality Councils (4/6) and consistent local primary care practice interdisciplinary leadership (4/6). Fourteen of 15 regionally approved innovation projects have been completed, three have undergone initial spread, five are prepared to spread, and two have completed toolkits that have been pretested in two to three sites and are now ready for external spread. DISCUSSION: EBQI-PACT has been feasible to implement in three participating healthcare systems in one VA region. Further development of methods for engaging patients in care design and for promoting interdisciplinary leadership is needed.

Original languageEnglish
Pages (from-to)589-597
Number of pages9
JournalJournal of General Internal Medicine
Volume29
Issue numberSUPPL. 2
DOIs
Publication statusPublished - Jul 2014
Externally publishedYes

Keywords

  • interdisciplinary leadership
  • logic model
  • patient-centered medical home
  • primary care
  • quality improvement

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