In 2010 the Veteran's Health Administration looked to implement a patient-centered medical home model across its entire system. The focus of this model — called Patient Aligned Care Team (PACT) — has been to restructure primary care to team-based care that is more comprehensive and coordinated and can improve health outcomes through better access and management.

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In a study published June 24 in JAMA Internal Medicine, Karin Nelson, MD, MSHS, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, et al. developed an index to measure the extent of PACT's implementation at each of the 913 Veteran's Health Administration clinics, and found the index score "was favorably associated with patient satisfaction, staff burnout, quality of care, and use of health care services."

With the index consisting of 53 individual items assigned to eight overarching PACT concepts — access, continuity of care, care coordination, comprehensiveness, self-management support, patient-centered care and communication, shared decision making, and delegation, staffing, and team functioning – results showed that compared with the 87 clinics in the lowest decile of the index, the 77 sites in the top decile exhibited significantly higher patient satisfaction (9.33 vs. 7.53; P < .001), higher performance on 41 of 48 measures of clinical quality, lower staff burnout, lower hospitalization rates for ambulatory care–sensitive conditions (4.42 vs. 3.68 quarterly admissions for veterans 65 years or older per 1000 patients; P < .001), and lower emergency department use (188 vs. 245 visits per 1000 patients; P < .001).

The authors caution that their results "may apply only to large integrated health systems that include a robust and integrated electronic health record and a well-developed quality improvement system that provides feedback to clinics and providers." They add that "all primary care providers in the Veteran's Health Administration, for example, have ready access to detailed information about their patient panels, including the likelihood of admission or death (updated weekly), as well as patients' use of a range of inpatient, outpatient, and care coordination services. However, as accountable care organizations evolve, this type of patient-centered measurement could be adopted by other large integrated health systems."

In a corresponding editorial comment, Richard Baron, MD, president and CEO of the American Board of Internal Medicine, Philadelphia, writes, "Just as the Veteran's Health Administration had to adapt the patient-centered medical home concept to its own context in developing and implementing the PACT model, practices that aspire to be a successful patient-centered medical home could assess their own performance for the constructs that underlie the [index] (asking, for example, 'Are we providing access? Do we have continuity? Do we offer shared decision making?'), and use that assessment as a less bureaucratic and more authentic measure of how likely the practice is to improve the patient experience, decrease staff burnout, and decrease total costs of care."

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