OBJECTIVES: We employed a partnered research healthcare delivery redesign process to improve care for high-need, high-cost (HNHC) patients within the Veterans Affairs (VA) healthcare system. METHODS: Health services researchers partnered with VA national and Palo Alto facility leadership and clinicians to: 1) analyze characteristics and utilization patterns of HNHC patients, 2) synthesize evidence about intensive management programs for HNHC patients, 3) conduct needs-assessment interviews with HNHC patients (n = 17) across medical, access, social, and mental health domains, 4) survey providers (n = 8) about care challenges for HNHC patients, and 5) design, implement, and evaluate a pilot Intensive Management Patient-Aligned Care Team (ImPACT) for a random sample of 150 patients. RESULTS: HNHC patients accounted for over half (52 %) of VA facility patient costs. Most (94 %) had three or more chronic conditions, and 60 % had a mental health diagnosis. Formative data analyses and qualitative assessments revealed a need for intensive case management, care coordination, transitions navigation, and social support and services. The ImPACT multidisciplinary team developed care processes to meet these needs, including direct access to team members (including after-hours), chronic disease management protocols, case management, and rapid interventions in response to health changes or acute service use. Two-thirds of invited patients (n = 101) enrolled in ImPACT, 87 % of whom remained actively engaged at 9 months. ImPACT is now serving as a model for a national VA intensive management demonstration project. CONCLUSIONS: Partnered research that incorporated population data analysis, evidence synthesis, and stakeholder needs assessments led to the successful redesign and implementation of services for HNHC patients. The rigorous design process and evaluation facilitated dissemination of the intervention within the VA healthcare system. IMPACT STATEMENT: Employing partnered research to redesign care for high-need, high-cost patients may expedite development and dissemination of high-value, cost-saving interventions.
OBJECTIVES: We employed a partnered research healthcare delivery redesign process to improve care for high-need, high-cost (HNHC) patients within the Veterans Affairs (VA) healthcare system. METHODS: Health services researchers partnered with VA national and Palo Alto facility leadership and clinicians to: 1) analyze characteristics and utilization patterns of HNHC patients, 2) synthesize evidence about intensive management programs for HNHC patients, 3) conduct needs-assessment interviews with HNHC patients (n = 17) across medical, access, social, and mental health domains, 4) survey providers (n = 8) about care challenges for HNHC patients, and 5) design, implement, and evaluate a pilot Intensive Management Patient-Aligned Care Team (ImPACT) for a random sample of 150 patients. RESULTS: HNHC patients accounted for over half (52 %) of VA facility patient costs. Most (94 %) had three or more chronic conditions, and 60 % had a mental health diagnosis. Formative data analyses and qualitative assessments revealed a need for intensive case management, care coordination, transitions navigation, and social support and services. The ImPACT multidisciplinary team developed care processes to meet these needs, including direct access to team members (including after-hours), chronic disease management protocols, case management, and rapid interventions in response to health changes or acute service use. Two-thirds of invited patients (n = 101) enrolled in ImPACT, 87 % of whom remained actively engaged at 9 months. ImPACT is now serving as a model for a national VA intensive management demonstration project. CONCLUSIONS: Partnered research that incorporated population data analysis, evidence synthesis, and stakeholder needs assessments led to the successful redesign and implementation of services for HNHC patients. The rigorous design process and evaluation facilitated dissemination of the intervention within the VA healthcare system. IMPACT STATEMENT: Employing partnered research to redesign care for high-need, high-cost patients may expedite development and dissemination of high-value, cost-saving interventions.
Authors: Randall S Brown; Deborah Peikes; Greg Peterson; Jennifer Schore; Carol M Razafindrakoto Journal: Health Aff (Millwood) Date: 2012-06 Impact factor: 6.301
Authors: Laura J Damschroder; David C Aron; Rosalind E Keith; Susan R Kirsh; Jeffery A Alexander; Julie C Lowery Journal: Implement Sci Date: 2009-08-07 Impact factor: 7.327
Authors: David A Dorr; Adam B Wilcox; Cherie P Brunker; Rachel E Burdon; Steven M Donnelly Journal: J Am Geriatr Soc Date: 2008-12 Impact factor: 5.562
Authors: Wei Yu; Arliene Ravelo; Todd H Wagner; Ciaran S Phibbs; Aman Bhandari; Shuo Chen; Paul G Barnett Journal: Med Care Res Rev Date: 2003-09 Impact factor: 3.929
Authors: Maria C Raven; Kelly M Doran; Shannon Kostrowski; Colleen C Gillespie; Brian D Elbel Journal: BMC Health Serv Res Date: 2011-10-13 Impact factor: 2.655
Authors: Donna M Zulman; Colin W O'Brien; Cindie Slightam; Jessica Y Breland; David Krauth; Andrea L Nevedal Journal: J Gen Intern Med Date: 2018-08-10 Impact factor: 5.128
Authors: Donna M Zulman; Evelyn T Chang; Ava Wong; Jean Yoon; Susan E Stockdale; Michael K Ong; Lisa V Rubenstein; Steven M Asch Journal: J Gen Intern Med Date: 2019-05 Impact factor: 5.128
Authors: Rifky Tkatch; Shirley Musich; Stephanie MacLeod; Kathleen Alsgaard; Kevin Hawkins; Charlotte S Yeh Journal: Gerontol Geriatr Med Date: 2016-09-18
Authors: M Alexis Kirk; Caitlin Kelley; Nicholas Yankey; Sarah A Birken; Brenton Abadie; Laura Damschroder Journal: Implement Sci Date: 2016-05-17 Impact factor: 7.327