. 2021 Nov;36(11):3366-3372.

doi: 10.1007/s11606-021-06869-4. Epub 2021 May 13.

Outcomes that Matter: High-Needs Patients' and Primary Care Leaders' Perspectives on an Intensive Primary Care Pilot

Michelle S Wong¹, Tana M Luger^{2

3}, Marian L Katz², Susan E Stockdale^{2

4}, Nate L Ewigman⁵, Jeffrey L Jackson^{6

7}, Donna M Zulman^{8

9}, Steven M Asch^{8

9}, Michael K Ong^{2

10

11

12}, Evelyn T Chang^{2

11

12}

Affiliations

¹ Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles HSR&D, Los Angeles, CA, USA. Michelle.Wong6@va.gov.
² Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles HSR&D, Los Angeles, CA, USA.
³ Covenant Health Network, Phoenix, AZ, USA.
⁴ Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
⁵ San Mateo Medical Center, San Mateo, CA, USA.
⁶ Department of Medicine, Zablocki VA Medical Center, Milwaukee, WI, USA.
⁷ Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
⁸ Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, Palo Alto, CA, USA.
⁹ Division of Primary Care and Population Health, Department of Medicine, Stanford University, Palo Alto, CA, USA.
¹⁰ Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
¹¹ Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
¹² Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.

PMID: 33987789
PMCID: PMC8606366
DOI: 10.1007/s11606-021-06869-4

Outcomes that Matter: High-Needs Patients' and Primary Care Leaders' Perspectives on an Intensive Primary Care Pilot

Michelle S Wong et al. J Gen Intern Med. 2021 Nov.

. 2021 Nov;36(11):3366-3372.

doi: 10.1007/s11606-021-06869-4. Epub 2021 May 13.

Authors

Affiliations

¹ Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles HSR&D, Los Angeles, CA, USA. Michelle.Wong6@va.gov.
² Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles HSR&D, Los Angeles, CA, USA.
³ Covenant Health Network, Phoenix, AZ, USA.
⁴ Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
⁵ San Mateo Medical Center, San Mateo, CA, USA.
⁶ Department of Medicine, Zablocki VA Medical Center, Milwaukee, WI, USA.
⁷ Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
⁸ Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, Palo Alto, CA, USA.
⁹ Division of Primary Care and Population Health, Department of Medicine, Stanford University, Palo Alto, CA, USA.
¹⁰ Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
¹¹ Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
¹² Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.

PMID: 33987789
PMCID: PMC8606366
DOI: 10.1007/s11606-021-06869-4

Abstract

Background: Quantitative evaluations of the effectiveness of intensive primary care (IPC) programs for high-needs patients have yielded mixed results for improving healthcare utilization, cost, and mortality. However, IPC programs may provide other value.

Objective: To understand the perspectives of high-needs patients and primary care facility leaders on the effects of a Veterans Affairs (VA) IPC program on patients.

Design: A total of 66 semi-structured telephone interviews with high-needs VA patients and primary care facility leaders were conducted as part of the IPC program evaluation.

Participants: High-needs patients (n = 51) and primary care facility leaders (n = 15) at 5 VA pilot sites.

Approach: We used content analysis to examine interview transcripts for both a priori and emergent themes about perceived IPC program effects.

Key results: Patients enrolled in VA IPCs reported improvements in their experience of VA care (e.g., patient-provider relationship, access to their team). Both patients and leaders reported improvements in patient motivation to engage with self-care and with their IPC team, and behaviors, especially diet, exercise, and medication management. Patients also perceived improvements in health and described receiving assistance with social needs. Despite this, patients and leaders also outlined patient health characteristics and contextual factors (e.g., chronic health conditions, housing insecurity) that may have limited the effectiveness of the program on healthcare cost and utilization.

Conclusions: Patients and primary care facility leaders report benefits for high-needs patients from IPC interventions that translated into perceived improvements in healthcare, health behaviors, and physical and mental health status. Most program evaluations focus on cost and utilization, which may be less amenable to change given this cohort's numerous comorbid health conditions and complex social circumstances. Future IPC program evaluations should additionally examine IPC's effects on quality of care, patient satisfaction, quality of life, and patient health behaviors other than utilization (e.g., engagement, self-efficacy).

Keywords: Veterans; high-risk high-need; intensive primary care; patient-centered outcomes; qualitative effects.

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Conflict of interest statement

The authors have no conflicts of interest to report.

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Outcomes that Matter: High-Needs Patients' and Primary Care Leaders' Perspectives on an Intensive Primary Care Pilot

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Outcomes that Matter: High-Needs Patients' and Primary Care Leaders' Perspectives on an Intensive Primary Care Pilot

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