Patient selection strategies in an intensive primary care program.

Area of Science:

• Health Services Research
• Primary Care Management
• Patient Selection Strategies

Background:

• Intensive primary care programs show variable clinical outcomes, potentially due to inconsistent patient selection.
• The US Veterans Health Administration (VHA) implemented the Patient Aligned Care Team Intensive Management (PIM) program across five medical centers.
• Understanding the PIM patient selection process and team perspectives is crucial for program effectiveness.

Purpose of the Study:

• To describe the patient selection process within the PIM program.
• To explore PIM team members' perspectives on the functioning of patient selection.

Main Methods:

• Exploratory sequential mixed-methods design combining qualitative interviews and electronic health record (EHR) data.
• Qualitative interviews conducted with 21 PIM team and facility leaders.
• Analysis of EHR data from 2,061 patients screened for PIM enrollment between July 2014 and September 2017.

Main Results:

• Over half of the 1,887 patients identified by standardized criteria were deemed inappropriate for PIM.
• Reasons for ineligibility included lack of ambulatory care sensitive conditions, living situation, or existing recommended care.
• Standardized criteria were a starting point, but team members required additional chart review and primary care team communication to assess complexity; differing program goal conceptualizations created enrollment disagreements.

Conclusions:

• Appropriate patient selection for intensive primary care necessitates a multifaceted approach.
• Integration of clinical judgment, case review, standardized criteria, and clearly defined program goals is vital.
• This combined strategy supports optimal patient enrollment in intensive primary care management programs.