Evaluation of a geriatrics primary care model using prospective matching to guide enrollment

Background Few definitive guidelines exist for rigorous large-scale prospective evaluation of nonrandomized programs and policies that require longitudinal primary data collection. In Veterans Affairs (VA) we identified a need to understand the impact of a geriatrics primary care model (referred to as GeriPACT); however, randomization of patients to GeriPACT vs. a traditional PACT was not feasible because GeriPACT has been rolled out nationally, and the decision to transition from PACT to GeriPACT is made jointly by a patient and provider. We describe our study design used to evaluate the comparative effectiveness of GeriPACT compared to a traditional primary care model (referred to as PACT) on patient experience and quality of care metrics. Methods We used prospective matching to guide enrollment of GeriPACT-PACT patient dyads across 57 VA Medical Centers. First, we identified matches based an array of administratively derived characteristics using a combination of coarsened exact and distance function matching on 11 identified key variables that may function as confounders. Once a GeriPACT patient was enrolled, matched PACT patients were then contacted for recruitment using pre-assigned priority categories based on the distance function; if eligible and consented, patients were enrolled and followed with telephone surveys for 18 months. Results We successfully enrolled 275 matched dyads in near real-time, with a median time of 7 days between enrolling a GeriPACT patient and a closely matched PACT patient. Standardized mean differences of < 0.2 among nearly all baseline variables indicates excellent baseline covariate balance. Exceptional balance on survey-collected baseline covariates not available at the time of matching suggests our procedure successfully controlled many known, but administratively unobserved, drivers of entrance to GeriPACT. Conclusions We present an important process to prospectively evaluate the effects of different treatments when randomization is infeasible and provide guidance to researchers who may be interested in implementing a similar approach. Rich matching variables from the pre-treatment period that reflect treatment assignment mechanisms create a high quality comparison group from which to recruit. This design harnesses the power of national administrative data coupled with collection of patient reported outcomes, enabling rigorous evaluation of non-randomized programs or policies.

Information and Communication Technologies (ICTs) Enabling Integrated Primary Care for Complex Patients: A Protocol for a Scoping Review

IntroductionAn increasing number of individuals are living with multiple chronic conditions, often combined with psychosocial complexities. For these patients with complex conditions, an integrated primary care model that provides care coordination and a team-based approach can help manage their multiple needs. Information and communication technologies (ICTs) are recognized as a critical enabler of integrated primary care. A better understanding of the use of ICTs in an integrated care setting and how ICTs are being leveraged would be beneficial to identify knowledge gaps and could lead to successful implementation for ICT-based interventions.ObjectiveThis study will systematically scope the literature on the topic of ICT-enabled integrated healthcare delivery models for patients with complex care needs to identify which technologies have been used in integrated primary care settings. MethodThis study protocol outlines a scoping review of the peer-reviewed literature, using Arksey and O’Malley’s (enhanced by Levac et al.) scoping review methodology. Peer-reviewed- literature will be identified using a multi-database search strategy. The results of the search will be screened, abstracted, and charted in duplicate by 6 research team members. DiscussionThe key findings of the study will be thematically mapped to describe the implemented ICTs aimed for complex patients within the integrated primary care model and interactions of the elements (ICT, health model, and targeted patients). This review will be the first step to formally identify how ICT is used to support integrated primary health care models. The results will be disseminated through peer-reviewed publications, conference presentations, and special interest groups.

177 Treating Chronic Pain and Preventing Opioid Use Disorders in the Underserved: An Integrated Primary Care Model

This poster builds on the CDC pain management guidelines and the current ASAM recommendations for substance use assessment to build an integrated primary care model for holistic chronic pain management in an urban, underserved primary care clinic. Using a case from our Federally Qualified Health Care Center, which operates in a southwest Denver clinic, a program of integrated care assessment, diagnosis, and holistic treatment planning is outlined for this client with chronic pain, physical, and behavioral health issues. Using a comprehensive care approach for complex clients, which are typical presentations for urban, underserved clients, we discuss the utilization of best practices in medication management for chronic pain (Alternatives to Opioids (ALTOS), prescribed and complementary and alternative practices (e.g., PT, acupuncture, etc), and behavioral health services (psychiatric assessment and treatment, psychotherapy, support groups, etc) to improve outcomes for our clients.