Miller Professor Contributes to Review of VA Patient-Centered Medical Homes

Olveen Carrasquillo, M.D., M.P.H., professor of medicine and public health sciences, Chief of the Division of General Internal Medicine and Director of Community Engagement at the Miami Clinical and Translational Science Institute (CTSI), was one of five editors for a supplement on the VA Healthcare System’s patient-centered medical homes published in the July issue of the Journal of General Internal Medicine.

Carrasquillo and the other editors reviewed more than 70 articles, selecting only 19 to be published to summarize the VA experience on the patient-centered medical homes initiative that launched nationally in 2010 through the Patient Aligned Care Teams (PACT) program. Funded by the VA Office of Patient Care Services’ Primary Care Program Office, the supplement shares the lessons learned by researchers and their clinical and policy partners during the various stages of implementing PACT.

“The patient-centered medical home is a promising model for transforming the delivery of primary care and to improve patient safety, quality and effectiveness of healthcare,” said Carrasquillo, who recognized several other UM and VA faculty who helped review the articles for the supplement. “I think the recent media attention on wait time at a few VA hospitals totally missed the boat. The real story is the herculean effort the VA has made over the past four years to orchestrate this impressive transformation. If the VA can do this nationally, we here at UM can do it too.”

The editors organized the PACT supplement to reflect different stages and levels of medical home implementation, from insights and challenges to implications for specialty care relationships and addressing the needs of special populations.

Although one article highlights the “moderate to extreme” challenges in pre-implementation stages, much of the responses to VA dissemination has been impressive. For example, with the launch of a national online repository of tools to facilitate PACT implementation, more than 6,000 staff members used the repository in the first 19 months of its availability. Strategies such as this one, the editors say, demonstrate positive outcomes that have implications for improving medical home coordination.

“Eliciting general staff experiences during PACT implementation revealed important insights,” the editors wrote, highlighting another article that describes “early enthusiasm among primary care staff for PACT concepts.”

Several articles focused explicitly on PACT team-based care, emphasizing the importance of teamlet models that are at the heart of PACT’s redesign of primary care staffing, while others examined role changes that led to effective and efficient teamwork, supporting the importance of the core objectives of continuity and access.

In one report, researchers compared primary care physician- versus clinical pharmacist-directed nurse case management of patients with poorly controlled hypertension. The findings suggest that clinical pharmacists can supervise multiple nurse care managers in dispensing medications to patients, potentially reducing delays related to physician access while increasing nurse care management capabilities.

The editorial team also included two articles on PACT for special populations.

“While early PACT implementation focused on primary care-based organizational changes, two articles in this supplement remind us of the importance of considering primary care received outside of general primary care settings,” the team wrote.

One article found that patients receiving PACT-centered care in VA HIV specialty care clinics were more satisfied than those without. Another team cited similar implications for delivering gender-sensitive comprehensive care to female veterans, who may be seen in separate women’s health clinics or general primary care clinics with varying levels of readiness for handling women’s primary health needs.

“We consider this set of articles to be a valuable and promising resource for clinical leaders, policy makers and primary care researchers,” the editors concluded.

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