VA Experience in Implementing Patient-Centered Medical Home Using a Breakthrough Series Collaborative

ABSTRACT 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