Creating Patient-Centered Medical Homes for Rural Veterans

This study identifies the extent and variability in the implementation of the patient-centered medical home model (PCMH) in primary care clinics within the Veterans Health Administration (VHA) system. A “meta-set” of defining elements from common PCMH models and with potential usefulness in the VHA was identified to create a readiness survey which was administered to 1,636 clinic healthcare providers and managers from VHA clinics. 528 (32.3%) completed the survey. Responses were stratified by geography and descriptively summarized using frequencies and percentages. Chi-square tests were used to assess differences among sub-sets. Findings reveal that care coordination and practice-based care team practices are not adopted broadly in VHA rural and urban clinics. About 29% of respondents indicated that a co-management plan is developed with the non-VA provider for patients seeking care from both VA and non-VA providers. Performance measurement/quality improvement and clinical information management practices are widely adopted in VHA rural and urban clinics. About 65.1% of respondents indicated that their clinic reviews data on patient satisfaction once a year. About 75% of respondents indicated that their clinic environment encourages discussion about evidence-based guidelines/practices that goes above and beyond those established nationally by the VHA. Additionally, 97.9% of respondents indicated that an up-to-date patient problem list was kept in the patient's medical record. Study findings have policy implications for determining the readiness of VHA clinics to implement various dimensions of the PCMH model that are theorized as ideal, especially for the benefit of increased access and quality of care for rural veterans.