VA experience in implementing Patient-Centered Medical Home using a breakthrough series collaborative.

BACKGROUND: Veterans Health Administration (VHA) seeks to improve the delivery of patient-centered care. A Patient-Centered Medical Home (PCMH) Model, named Patient Aligned Care Team (PACT), was implemented to transform the VHA primary care delivery process. VHA used a collaborative learning model as a key approach to disseminate PACT concepts and changes. OBJECTIVE: To describe and examine VHA's experience disseminating PACT transformation using a Breakthrough Series Collaborative method. DESIGN: Observational study. PARTICIPANTS: Approximately 250-350 individuals from 141 teams participated in six face-to-face learning sessions across 21 months. MAIN MEASURES: 1) PACT Collaborative participant surveys; 2) Coach Assessment Scores and Plan-Do-Study-Act (PDSA) data; and 3) PACT Compass (national measures to assess PACT implementation within VA healthcare system). KEY RESULTS: A majority of the participants indicated that the PACT Collaborative was necessary to implement PACT. The number of PDSAs increased steadily during the Collaborative period; 93 % (n = 1,547) of PDSAs were successfully implemented. Teams successfully achieved over 80 % of their aims, which were highly correlated with PDSAs implemented (R(2) = 0.88). The most successful aims achieved were offering same-day appointments, increasing non-face-to-face care, and improving team communication. PACT Compass indicated an improvement after the Collaborative (p-value < .000), and providers observed differences in their care practice (p-value < 0.002). This positive impact may be due to the spread of the PACT Model through the PACT Collaborative, among other learning initiatives. CONCLUSIONS: For complex collaborative models such as PACT, more than three learning sessions may be required. As VHA continues to disseminate the PACT Model through primary care, into specialty/surgical care and beyond, the Collaborative Learning Model may continue to be an effective way to leverage a small number of faculty, coaches, and industrial engineers across an extremely large population.

Using a virtual breakthrough series collaborative to improve access in primary care.

BACKGROUND: The Institute for Healthcare Improvement (IHI) pioneered the Breakthrough Series (BTS), a short-term improvement project that convenes, in three face-to-face meetings, hospital or clinic teams to make rapid, significant improvement. A distance-learning (virtual) version of the BTS-a VBTS-was conducted. METHODS: A model VBTS was tested with 20 organizations, using a well-established topic: improving access and efficiency in primary care. This VBTS took place by Internet and telephone, using Web-based collaboration software and audioconferencing. RESULTS: For the 17 organizations completing the VBTS, the average number of days to third-next-available appointment fell from 23 to 10 days (July 2004-June 2005). The Improvement Assessment Scale showed 59% of teams at level 4 or above ("significant" improvement, with most changes implemented, and evidence of sustained improvement in outcomes and plans for spread). Potential direct cost savings were about $12,000 as compared with a traditional collaborative. Six months after the VBTS's conclusion, 70% of the teams that achieved significant improvement either maintained gains or improved their results. DISCUSSION: Outcomes in a VBTS are potentially comparable to those in a traditional collaborative, at substantially lower cost. Prerequisites for success include senior leadership's involvement, team members' ability to participate, and information technology support.