Integrating Personalized Care Planning into Primary Care: a Multiple-Case Study of Early Adopting Patient-Centered Medic
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Center for Evaluating Patient-Centered Care in VA, Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Memorial Veterans Hospital US Department of Veterans Affairs, Bedford, MA, USA; 2Heller School for Social Policy and Management, Brandeis University , Waltham , MA , USA; 3Department of Health Law, Policy, and Management, Boston University School of Public Health , Boston , MA , USA; 4Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School , Worcester , MA , USA; 5Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA; 6Department of Psychology, University of Maine , Orono , ME , USA; 7 Center for Healthcare Organization and Implementation Research, Boston VA Healthcare System, US Department of Veterans Affairs , Boston , MA , USA.
BACKGROUND: Personalized care planning is a patientcentered, whole-person approach to treatment planning. Personalized care plans improve patient outcomes and are now mandated for chronic care management reimbursement. Yet guidance on how to best implement personalized care planning in practice is limited. OBJECTIVE: We examined the adoption of personalized care planning in patient-centered medical home (PCMH) clinics to identify processes and organizational characteristics that facilitated or hindered use in routine practice. DESIGN: Qualitative multiple-case study design. We conducted site visits at PCMH clinics in four US Veterans Health Administration (VHA) medical centers. Data included 10 general clinic observations, 34 direct observations of patient-provider clinical encounters, 60 key informant interviews, and a document review. Data were analyzed via qualitative content analysis using a priori and emergent coding. PARTICIPANTS: Employees and patients participating in clinical encounters in PCMH clinics at four VHA medical centers. KEY RESULTS: Each clinic used a distinct approach to personalized care planning: (1) distributed tasks approach; (2) two-tiered approach; (3) health coaching approach; and (4) leveraging a village approach. Each varied in workflow, healthcare team utilization, and degree of integration into clinical care. Across sites, critical components for implementation included expanding planning beyond initial assessment of patient priorities; framing the initiative for patients; using a team-based approach to care plan development and updates; using communication mechanisms beyond the electronic health record; and engaging stakeholders in implementation planning.
Prior Presentations This paper has not previously been presented. Received March 1, 2019 Revised July 25, 2019 Accepted September 16, 2019
CONCLUSIONS: Personalized care planning is a novel patient-centered practice, but complicated to implement. We found variation in effective implementation and identified critical components to structuring this practice i
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