Journal article
Patient Aligned Care Team (PACT) Performance in Urban and Rural VHA Primary Care Clinics: A Mixed Methods Study
The Journal of rural health, Vol.37(2), pp.426-436
2021
DOI: 10.1111/jrh.12490
PMID: 32632998
Abstract
Purpose
To assess differences in Patient Aligned Care Team (PACT) performance between rural and urban primary care clinics within the Veterans Health Administration (VHA).
Methods
An Explanatory Sequential Mixed Methods design was conducted using VHA administrative data to assess performance of a national sample of 891 VHA primary care clinics. Generalized Estimating Equations with repeated measures were used to estimate associations between rurality and process‐oriented endpoints including: chronic disease management through telehealth; use of telephone visits, group visits or secured messaging; same‐day access; continuity with primary care provider; and postdischarge follow‐up. Qualitative data collected during on‐site visits with 5 clinics were used to provide insights into PACT processes from the perspectives of staff in rural and urban clinics.
Findings
After adjusting for patient‐ and practice‐level characteristics, clinics located in large rural or small/isolated rural areas demonstrated difficulty enhancing access through use of telephone visits, group visits, or secured messaging and completing postdischarge follow‐up calls, compared to urban clinics. Qualitative analysis indicated that staff from both rural and urban clinics reported similar barriers implementing these PACT processes. Both patient and staff behaviors and preferences impact implementation of these processes. Distance to care and access to high‐speed Internet were also reported as barriers.
Conclusions
This study contributes to the understanding of PACT performance in rural settings by highlighting ways contextual and behavioral factors relate to performance. Increasing implementation of patient‐centered medical home (PCMH) models, such as PACT, will require additional attention to the complex relationships between the practice and surrounding context.
Details
- Title: Subtitle
- Patient Aligned Care Team (PACT) Performance in Urban and Rural VHA Primary Care Clinics: A Mixed Methods Study
- Creators
- Michelle A Lampman - Mayo ClinicKenda R. Stewart Steffensmeier - Iowa City VA Health Care SystemHeather Schacht Reisinger - University of IowaMary Vaughan Sarrazin - University of IowaMelissa J. A Steffen - Iowa City VA Health Care SystemSamantha L Solimeo - Veterans Rural Health Resource CenterGreg L Stewart - University of IowaKeith J Mueller - University of Iowa
- Resource Type
- Journal article
- Publication Details
- The Journal of rural health, Vol.37(2), pp.426-436
- DOI
- 10.1111/jrh.12490
- PMID
- 32632998
- ISSN
- 0890-765X
- eISSN
- 1748-0361
- Number of pages
- 11
- Language
- English
- Date published
- 2021
- Academic Unit
- Health Management and Policy; Management and Entrepreneurship ; Center for Social Science Innovation; Public Policy Center (Archive); General Internal Medicine; Internal Medicine
- Record Identifier
- 9984214813002771
Metrics
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