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QUERI and Office of Geriatrics and Extended Care Launch National Evaluation of VA's Geriatric Patient-aligned Care Team (GeriPACT)

The population of Veterans aged older than 85 nearly tripled between 2000 and 2010, and the number of high-priority Veterans with service-connected disabilities of 70% or higher age 65 and older enrolled in VA is expected to double in the next decade.¹ Thus, identifying cost-efficient and effective care for this population is critical. The majority of older Veterans in VA receive care through primary care.² Yet, their needs—typically multiple chronic conditions, functional limitations, and psychosocial overlays (including declining cognition) that often accompany advanced age—are often not easily accommodated in standard Patient-Aligned Care Teams (PACT), VA's signature medical home model. Many PACTs lack the geriatrics expertise or ability to coordinate care provided by diverse specialists with advanced training in co-managing complex geriatric care needs within the allotted 30-minute appointment.

To create a mechanism to better serve the increasing clinic-based care needs of older Veterans, the Office of Geriatrics and Extended Care (GEC) has encouraged the development and implementation of Geriatric Primary Care clinics, which since the introduction of PACT in 2010, have been termed GeriPACT. GeriPACTs offer an alternative to standard PACTs by providing frail, elderly Veterans and their caregivers with access to the most appropriate care for their healthcare needs with a single point-of-contact for interdisciplinary geriatric healthcare. With longer visits and a focus on the importance of patient preferences and care needs, the GeriPACT model should:

• Enhance coordination of care for high-risk patients;
• Provide quality of care for Veterans with complex medical conditions and psychosocial issues through personalized, proactive, and patient-centered care; and
• Focus on team behaviors, processes, and systems that promote a positive culture of service.

GeriPACT providers also enhance the work of PACT teams by educating them on the range of geriatric syndromes and challenges that constitute much of their workload. Close collaboration and team work between PACT and GeriPACT requires cooperation in scheduling, staffing, space assignment, referral criteria, and transfer protocols. GeriPACTs can expand PACT access by removing Veterans who require more attention from the primary care patient mix, allowing PACT providers to devote more time to mainstream patients.² Thus, coordination with GeriPACT enhances PACT's abilities to devote time and clinical expertise to less complex geriatric and non-geriatric PACT patients. Despite the apparent validity of these claims, there has been scant evaluative work to identify to what extent and under what conditions such care transformation occurs.

The GeriPACT model has not been thoroughly studied and little is known about how GeriPACTs are structured; how variations in programs across VA medical centers influence the care that Veterans receive; or whether GeriPACTs improve the patient and provider experience.

GeriPACT investigators have partnered with GEC to conduct an evaluation of GeriPACT implementation in the VA healthcare system. The primary objective of this partnered evaluation initiative (PEI) is to conduct an observational assessment of GeriPACT implementation to support rapid translation of the findings into practice. Specific aims include:

• Assessing GeriPACT implementation adherence and service outcomes;
• Examining the relationship of implementation adherence, robust team-based care, and patient utilization and GeriPACT costs;
• Comparing utilization and cost outcomes for similar GeriPACT and PACT patients over time; and
• Identifying important organizational contextual factors associated with GeriPACT performance by conducting an in-depth evaluation at eight VAMCs with high GeriPACT adherence, but that vary on other service outcomes directly related to GeriPACT performance.

Findings from this evaluation are expected to improve quality of care in the elderly Veteran population, as well as both patient and staff satisfaction. This partnered evaluation also may result in reducing the likelihood of costly healthcare services, such as hospitalization or long-term institutionalization, as well as functional decline.

For more information about GeriPACT, please contact Jennifer Sullivan, PhD, at Jennifer.Sullivan@va.gov.

References

1. Edes T. Geriatrics and Extended Care Goals and Metrics for FY2015. Internal presentation to U.S. Department of Veterans Affairs, Central Office, Washington DC. (January 13, 2015; cited August 20, 2015 Aug 20).

2. Shay K, Schectman G. Primary care for older Veterans. Generations - Journal of the American Society on Aging. 2010; 34(2):35-42.