Primary Health Care Clinical Trial
Official title:
Evaluating Innovative Care Models for High-Utilizing Patients
This evaluation will examine the feasibility, implementation, and effectiveness of a quality improvement intervention-Intensive Management Patient Aligned Care Team (ImPACT)-for high-risk patients.
Background: VA's highest-utilizing patients generally have complicated health care
needs-including complex and multiple chronic conditions, comorbid mental health conditions,
and social stressors-that contribute to high rates of hospitalization, emergency services,
and specialty care use. Inspired by emerging intensive primary care models for
high-utilizers, VA Palo Alto launched a quality improvement program to augment existing VA
primary care (provided by Patient Aligned Care Teams, PACT) with intensive care delivered by
a multidisciplinary team. The Intensive management PACT (ImPACT) intervention encompasses a
number of evidence-based strategies, including a comprehensive intake process, coordination
of specialty care, chronic condition case management, provision of social services, rapid
response to deteriorations in health, and facilitation of transitions after high-acuity
events.
The ImPACT program was designated as quality improvement (non-research) by the Palo Alto VA.
A retrospective evaluation using deidentified data was approved by the Stanford University
IRB.
Objectives: The objectives of this evaluation are to assess ImPACT's feasibility,
implementation, and effectiveness, and lay the groundwork for future larger-scale efforts and
evaluations within the VA system.
Methods: We will partner with the implementation team of VA Palo Alto's ImPACT clinic to
conduct a Hybrid Type 1 evaluation of the program's feasibility, implementation, and
effectiveness. Specifically, the evaluation will aim to:
1. Evaluate the feasibility and implementation of the pilot ImPACT intervention. Using
semi-structured interviews with ImPACT and PACT team members and leadership, we will
evaluate the success of intervention delivery, including patient identification,
recruitment, and retention; provision and uptake of planned services; and monitoring of
patient participation and key outcomes.
2. Evaluate ImPACT's effect on utilization and costs of care. We will use a
difference-in-differences approach, wherein we compare changes in VA health care costs
(total, as well as inpatient, outpatient, and fee-basis) and utilization (including
hospitalizations, emergency department visits, and specialty care) among ImPACT patients
and high-utilizing patients who are receiving usual PACT care.
3. Examine the association between ImPACT participation and patient-centered outcomes.
Using data from surveys administered in the ImPACT clinic, we will assess patient
satisfaction with the ImPACT intervention and overall care, as well as changes in
patient-reported outcomes, including health status, symptom burden, and function.
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