VA experience in implementing Patient-Centered Medical Home using a breakthrough series collaborative.

Area of Science:

• Healthcare delivery transformation
• Collaborative learning models in healthcare
• Patient-centered medical home (PCMH) implementation

Background:

• The Veterans Health Administration (VHA) aimed to enhance patient-centered care delivery.
• The Patient Aligned Care Team (PACT) model was implemented to transform primary care.
• A collaborative learning model was central to disseminating PACT concepts and changes.

Purpose of the Study:

• To describe and evaluate the VHA's experience disseminating the PACT transformation.
• To assess the effectiveness of the Breakthrough Series Collaborative method in PACT implementation.

Main Methods:

• An observational study design was employed.
• Approximately 250-350 individuals from 141 teams participated in six learning sessions over 21 months.
• Data were collected through participant surveys, coach assessments, Plan-Do-Study-Act (PDSA) data, and PACT Compass measures.

Main Results:

• Most participants found the PACT Collaborative essential for PACT implementation.
• PDSA implementation increased steadily, with 93% successfully executed.
• Teams achieved over 80% of their aims, strongly correlating with PDSA implementation; key successes included same-day appointments, increased non-face-to-face care, and improved team communication.

Conclusions:

• Complex models like PACT may necessitate more than three learning sessions.
• The Collaborative Learning Model proved effective for disseminating the PACT Model across VHA.
• This model efficiently leverages limited resources to impact a large patient population.