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What are the key elements for implementing intensive primary care? A multisite Veterans Health Administration case
Evelyn T Chang1, Pushpa V Raja2, Susan E Stockdale3
1Department of General Internal Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; Department of Medicine, University of California at Los Angeles, Los Angeles, CA, United States; VA Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA, United States.
Healthcare (Amsterdam, Netherlands)
|November 6, 2017
Summary
Intensive primary care programs for high-need patients evolved to include interdisciplinary teams and comprehensive services. Standardization of these elements is key for scalable dissemination in health systems.
Area of Science:
- Health Services Research
- Primary Care Medicine
- Healthcare Management
Background:
- Intensive primary care programs are utilized by health systems to manage high-need, high-cost patients.
- Effective implementation strategies for these programs are under active discussion.
Purpose of the Study:
- To analyze the evolution and convergence of intensive primary care program elements within the Veterans Health Administration (VHA).
- To identify critical components for successful implementation targeting high-risk Veterans.
Main Methods:
- The Veterans Health Administration (VHA) implemented five distinct intensive primary care programs in 2014.
- Programmatic elements were tracked and analyzed for convergence over time.
Main Results:
- Programs converged on 11 key elements: interdisciplinary teams, chronic disease management, comprehensive assessment, care/case management, transitional care, home visits, pharmaceutical services, self-management support, caregiver support, health coaching, and advanced care planning.
- Inclusion of social workers and mental health providers proved critical for addressing psychosocial needs.
- A central implementation coordinator facilitated program feature convergence across sites.
Conclusions:
- Intensive primary care programs benefit from a standardized set of core components and interdisciplinary team composition.
- Future VHA iterations aim to standardize staffing and features for scalable program dissemination.
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