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VA Healthcare-VISN 4


What is a Demonstration Lab?

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VHA primary care leaders established demonstration laboratories to evaluate and enhance the system-wide transformation of primary care through PACT. CEPACT’s work is focused on VISN 4, but PACT is being implemented across the country.

VISN 4 (Pennsylvania and Delaware)

To date, CEPACT performed a multi-pronged, regional evaluation of different aspects of the PACT rollout, focusing on staff experiences and perspectives as well as facilitators and barriers to PACT implementation. Additionally, CEPACT-funded pilot projects tested multiple PACT-related innovations. Research activities included site visits, key informant interviews, video observation of clinical appointments, staff surveys, and secondary analysis of medical record data.

Over the next few years, we will be evaluating different types of practices to improve patient engagement across the VA system. To accomplish this, we are visiting medical centers and clinics nationally and interviewing staff to hear about what they do to engage their patients in care. We are also looking at specific facility characteristics to understand what types of facilities are most successful in achieving patient-centered care. These activities will help us understand what is linked with patients’ positive experiences, and how this varies by race and ethnicity.

Findings from this work will inform dissemination of best practices to all of VISN 4 and ultimately to the development of a tool kit for disseminating the best practices nationwide.

Current activities:

  • Qualitative interviews with Veterans to assess racial disparities in satisfaction with care
  • An analysis that focuses on identifying organizational characteristics associated with performance using data from all VAMCs nationally and on racial and ethnic disparities performance on patient centered metrics.
  • In depth interviews with primary care leads, nurse manager, and patient advocates at selected sites within VISN 4 and across the country;
  • Site visits to selected sites to assess best practices in patient engagement; activities at site visits include guided tours, clinic observations, patient shadowing, and interviews with all levels of staff;
  • Implementation and evaluation of an intervention to improve patient engagement across the the VISN.

There are three other demonstration labs (Demo Labs) conducting regional evaluations of different facets of the PACT rollout and testing PACT-related innovations for subsequent spread. A Demonstration Lab Coordinating Center, located in Seattle, Washington, is tasked with coordination of Lab activities and national evaluation of PACT deployment.

VISN 6 (West Virginia, Virginia, and North Carolina)

The primary objective of the VISN 6 Demonstration Laboratory is to facilitate rapid implementation of PACT evaluation of process measures that affect efficiency of operational flow associated with clinical outcomes and customer service outcomes. These outcomes will be achieved through a phased implementation process across the duration of the Demonstration Laboratory project and will include quantitative and qualitative analyses, and utilize six sigma principles as a primary evaluation platform. Active projects include assessment of how internal and external socio-political events have affected implementation and efficiency of PACT, evaluating methods for improving current use of the electronic health record in order to improve efficiency and reduce staff stress/burnout, and collaboration with Booz Allen Hamilton to assess contextual factors that impact PACT implementation at the team and medical center level.

VISN 22 (Southern California and Nevada area)

The Veterans Assessment & Improvement Laboratory (VAIL) is the VISN 22 Demonstration Laboratory with intervention and evaluation components focused on primary care Patient Aligned Care Teams (PACT). VAIL 2.0 has 2 primary foci. The first is identification and spread of PACT success. This focus addresses three specific themes—identification of high success sites and their best practices; implementation of methods for spread of best practices to lower performing sites; and evaluation of spread methods. As a secondary, developmental focus directed at barriers to PACT progress, VAIL will confront the issue of care, resource, and management coordination of PACT with its “neighborhood”, defined as the VA medical center services and settings that are not within PACT organizationally but indirectly affect PACT success.

VISN 23 (Iowa, Minnesota, Nebraska, North Dakota, South Dakota and portions of Illinois, Kansas, Missouri, Wisconsin, and Wyoming)

During the FY15-FY19 funding cycle, the VISN 23 PACT Demonstration Laboratory will have a central focus on studying innovative strategies to improve care coordination, with emphasis on improving integration, communication, and information flow within and between care teams. Efforts targeted at improving communication within primary care teams will include the continuation of a longitudinal assessment of Team and Individual Role Perceptions Survey (TIRPS) of all primary care providers and staff in VISN 23 and dissemination of feedback reports that allow PACTs to monitor their level of team functioning. To facilitate communication between PACT and non-PACT providers, the Lab will focus on understanding how PACT teams can better coordinate services outside primary care, particularly in rural settings. To meet operational needs as they arise, the VISN 23 PACT Demo Lab will continue to refine analyses related to PACT performance, with emphasis on projects designed to identify and communicate facilitators that will inform the acceleration of PACT implementation.