The Veterans Affairs Patient Aligned Care Team (VA PACT), a New Benchmark for Patient-Centered Medical Home Models: A Review and Discussion

Objective: Conduct a literature review on existing patient-centered medical home (PCMH) models and outline the differences and contributions

Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration

Background Facilitation is a key component for successful implementation in several implementation frameworks; however, there is a paucity of research specifying this component. As part of a stroke quality improvement intervention in the Veterans Health Administration (VHA), facilitation plus data feedback was compared to data feedback alone in 11 VA medical facilities. The objective of this study was to elucidate upon the facilitation components of the stroke quality improvement. Methods We conducted a secondary evaluation of external facilitation using semi-structured interviews. Five facilitators and two program directors were interviewed. Qualitative analysis was performed on transcribed interviews to gain an understanding of the role and activities of external facilitators during the on-site and telephone facilitation. Quantitative frequencies were calculated from the self-reported time spent in facilitation tasks by facilitators. Results The external facilitators saw their role as empowering the clinical teams to take ownership of the process changes at the clinical sites to improve their performance quality. To fulfill this role, they reported engaging in a number of core tasks during telephone and on-site visits including: assessing the context in which the teams were currently operating, guiding the clinical teams through their planned changes and use of process improvement tools, identifying resources and making referrals, holding teams accountable for plan implementation with on-site visits, and providing support and encouragement to the teams. Time spent in facilitation activities changed across time from guiding change (early) to supporting efforts made by the clinical teams (later). Facilitation activity transitioned to more monitoring, problem solving, and intentional work to hand over the clinical improvement process to the site teams with the coach’s role being increasingly that of a more distant consultant. Overall, this study demonstrated that external facilitation is not an event but rather a process where relationships and responsibilities evolve over time. Conclusions This study shows that external facilitation involves core elements related to communication, relationship building, methods training, monitoring performance over time, and facilitating team-based problem solving. Importantly, this work demonstrates the fluid nature of external facilitation over time, as teams learn, grow, change, and experience changing contexts

Development of a predictive model for low back musculoskeletal disorders based on occupational and lifestyle risk factors

Low back musculoskeletal disorders (MSDs) contribute to tremendous cost to employers and human suffering to employees. This study addresses the multi-factorial health and safety risk factors related to low back MSDs in the most comprehensive approach to date. At a Midwest university, existing workplace injury data were combined with health risk assessment data and analyzed using a logistic model to determine the associated low back MSDs risk factors: age, cause of injury, night shift, fatigue, emotional health, stress level and physical & emotional impairment. The impact (based on the odds ratio) of each of these seven risk factors on the occurrence of low back MSDs differed significantly. Age is an effect modifier altering the odds ratio of the risk factors associated with low back MSDs. For the four decades between 20 through 60 years, each of the four age groups showed a unique occupational and lifestyle risk factor profile that is associated with low back MSDs. For ages 20–30, employees reported lifting, twisting and/or bending and being fatigued, for 30–40 employees reported lifting, twisting and/or bending and being emotionally tired, for 40–50 employees reported lifting, twisting and/or bending, slips, trips and/or falls and chronic physical health issues, and for 50–60 employees reported lifting, twisting and/or bending, slips, trips and/or falls, and poor physical health. Generally, employees 40 years and younger reported more lifting, twisting and/or bending and emotional risk factors, whereas, employees 40 years and older reported lifting, twisting and/or bending, slips, trips and/or falls and physical risk factors were associated with low back MSDs. It is suggested that in order to reduce low back MSDs from lifting, twisting and/or bending in the workforce, preventative strategies such as ergonomics and wellness programs to reduce such injuries should focus on controlling the varying occupational and lifestyle risk factors within the four age groups between 20 through 60 years old. For employees less than 40 years old, the focus for reducing low back MSDs should be on understanding, managing, and preventing lifting, twisting and/or bending and emotional health issues. For employees 40 years and older, the focus for reducing low back MSDs should be on understanding, managing, and preventing lifting, twisting and/or bending, slips, trips and/or falls and physical health issues