Program for Research on the Outcomes of VA Education (PROVE)

• Change in Smoking Status [ Time Frame: Baseline and 12 months ] [ Designated as safety issue: No ]
  clinical outcome
  
  
• Change in Blood Pressure Reading [ Time Frame: Baseline and 12 months ] [ Designated as safety issue: No ]
  clinical outcome
  
  

• Change in weight [ Time Frame: Baseline and most recent at 12 months ] [ Designated as safety issue: No ]
  
• Change in Patient Activation [ Time Frame: 6 months and 12 months ] [ Designated as safety issue: No ]
  The Patient Activation Measure (PAM) is used to assess patients' self-reported knowledge, skill, and confidence in self-managing of health and chronic conditions
  
  
• Change in Patient Perceptions of Quality of Care [ Time Frame: 6 months and 12 months ] [ Designated as safety issue: No ]
  
• Change in Provider Behavior change expertise [ Time Frame: 6 months and 12 months ] [ Designated as safety issue: No ]
  
• Change in Provider Self-efficacy with Panel Management Tasks [ Time Frame: Baseline and 12 months ] [ Designated as safety issue: No ]
  
• Change in Provider Job Satisfaction [ Time Frame: Baseline and 12 months ] [ Designated as safety issue: No ]
  
• Change in Microsystem function and collective efficacy [ Time Frame: Baseline and 12 months ] [ Designated as safety issue: No ]
  
• Change in Provider's assessments of training that they received in panel management and working within a PACT team [ Time Frame: Baseline and 12 months ] [ Designated as safety issue: No ]
  
• Change in Proportion of panel smokers offered smoking cessation resources by study arm [ Time Frame: Baseline and 12 months ] [ Designated as safety issue: No ]
  
• Change in Proportion of smokers on the panel received any cessation medications [ Time Frame: Baseline and 12 months ] [ Designated as safety issue: No ]
  This information will be culled from the Vista Smoking Database
  
  

• Change in Health care usage [ Time Frame: Baseline and 12 months ] [ Designated as safety issue: No ]
  Number of primary care visits, mental health visits, emergency room/urgent care visits and the number of VA hospitalizations
  
  
• Change in Patient-level costs [ Time Frame: Baseline and 12 months ] [ Designated as safety issue: No ]
  Outpatient primary care visits, mental health visits, pharmacy and hospitalizations from the VA Decision Support System
  
  

Objective:

The specific aims for this study are: (1) to identify health professional educational and clinical microsystem determinants of outcomes for hypertension and smoking cessation in veterans. (2) to test the efficacy of three increasingly intensive methods for implementing panel management strategies among health care providers in VA primary care clinics: providing only panel data, providing panel management support, and providing support plus clinical microsystem-enhancing education and training.

Research design:

This project will consist of two phases. Phase I (one year) is the development of the necessary measurement and data infrastructure to assess health professional education, microsystem function, and clinical outcomes. In Phase 2 (two years) the study team will conduct a clinical demonstration project, comparing three interventions in a randomized controlled trial. Primary care teams will be randomly allocated to one of three arms: 1) panel management data, 2) panel management data and support, and 3) panel management data, support and education. The investigators will assess the impact of the implementation of panel management on primary patient outcomes in hypertension and smoking cessation (blood pressure and quit rates). The investigative team will also assess the impact of the implementation of panel management on secondary, intermediary, patient (patient activation, adherence, behavior change), provider (knowledge and attitudes, self-efficacy, job satisfaction) and microsystem outcomes (collective efficacy, teamwork, use of data, redesign of patient processes and provider roles/responsibilities, use of panel management strategies).

Methodology:

The study will utilize a multi-method, quasi-experimental design at VA NYHHS. Primary care is delivered through two teams at the Manhattan and five teams at the Brooklyn campuses. Patients, staff, nurses, and physicians are assigned to specific teams, thereby limiting contamination in this study.