Skip to main content

Veterans Affairs Continuity Clinics

  • Chapter
  • First Online:
Leading an Academic Medical Practice

Abstract

Many Veterans Affairs (VA) hospitals are also aligned with medical schools, which present an opportunity to integrate its internal medicine residents into a primary care continuity clinic. The ambulatory care model used in the VA is the Patient Aligned Care Team (PACT), a variant of the patient-centered medical home. This chapter offers support for the delivery of a high-quality clinical experience to residents as well as veterans, with discussion of utilizing PACT resources and modifying resident schedules to obtain equitable gender and case mix.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Office of Academic Affiliations: Medical and Dental Education Program 2016. https://www.va.gov/oaa/gme_default.asp

  2. Jha AK, Perlin JB, Kizer KW, Dudley RA. Effect of the transformation of the veterans affairs health care system on the quality of care. N Engl J Med. 2003;348(22):2218–27.

    Article  PubMed  Google Scholar 

  3. Jha AK, Perlin JB, Steinman MA, Peabody JW, Ayanian JZ. Quality of ambulatory care for women and men in the Veterans Affairs Health Care System. J Gen Intern Med. 2005;20(8):762–5.

    Article  PubMed  PubMed Central  Google Scholar 

  4. ACGME program requirements for graduate medical education in internal medicine. Chicago: Accreditation Council for Graduate Medical Education; 2016. p. 38.

    Google Scholar 

  5. Nadkarni M, Reddy S, Bates CK, Fosburgh B, Babbott S, Holmboe E. Ambulatory-based education in internal medicine: current organization and implications for transformation. Results of a national survey of resident continuity clinic directors. J Gen Intern Med. 2011;26(1):16–20.

    Article  PubMed  Google Scholar 

  6. Liu CF, Chapko M, Bryson CL, Burgess JF, Fortney JC, Perkins M, et al. Use of outpatient care in Veterans Health Administration and Medicare among veterans receiving primary care in community-based and hospital outpatient clinics. Health Serv Res. 2010;45(5 Pt 1):1268–86.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gupta R, Davis E, Horton C. Interval examination: building primary care teams in an urban academic teaching clinic. J Gen Intern Med. 2013;28(11):1517–21.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Schectman G, Stark R. Orchestrating large organizational change in primary care: the Veterans’ Health Administration experience implementing a patient-centered medical home. J Gen Intern Med. 2014;29(Suppl 2):S550–1.

    Article  PubMed  Google Scholar 

  9. Galen BT. In support of residency training at an academic veterans hospital. Acad Med. 2012;87(8):993–4.

    Article  PubMed  Google Scholar 

  10. Yoon J, Rose DE, Canelo I, Upadhyay AS, Schectman G, Stark R, et al. Medical home features of VHA primary care clinics and avoidable hospitalizations. J Gen Intern Med. 2013;28(9):1188–94.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Farmer MM, Rose DE, Rubenstein LV, Canelo IA, Schectman G, Stark R, et al. Challenges facing primary care practices aiming to implement patient-centered medical homes. J Gen Intern Med. 2014;29(Suppl 2):S555–62.

    Article  PubMed  Google Scholar 

  12. Bidassie B, Davies ML, Stark R, Boushon B. VA experience in implementing Patient-Centered Medical Home using a breakthrough series collaborative. J Gen Intern Med. 2014;29(Suppl 2):S563–71.

    Article  PubMed  Google Scholar 

  13. Chaiyachati KH, Gordon K, Long T, Levin W, Khan A, Meyer E, et al. Continuity in a VA patient-centered medical home reduces emergency department visits. PLoS One. 2014;9(5):e96356.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Rodriguez HP, Giannitrapani KF, Stockdale S, Hamilton AB, Yano EM, Rubenstein LV. Teamlet structure and early experiences of medical home implementation for veterans. J Gen Intern Med. 2014;29(Suppl 2):S623–31.

    Article  PubMed  Google Scholar 

  15. Chang A, Bowen JL, Buranosky RA, Frankel RM, Ghosh N, Rosenblum MJ, et al. Transforming primary care training—patient-centered medical home entrustable professional activities for internal medicine residents. J Gen Intern Med. 2013;28(6):801–9.

    Article  PubMed  Google Scholar 

  16. Brienza RS, Zapatka S, Meyer EM. The case for interprofessional learning and collaborative practice in graduate medical education. Acad Med. 2014;89(11):1438–9.

    Article  PubMed  Google Scholar 

  17. Brienza RS. At a crossroads: the future of primary care education and practice. Acad Med. 2016;91(5):621–3.

    Article  PubMed  Google Scholar 

  18. Doolittle BR, Tobin D, Genao I, Ellman M, Ruser C, Brienza R. Implementing the patient-centered medical home in residency education. Educ Health (Abingdon). 2015;28(1):74–8.

    Article  Google Scholar 

  19. VHA Handbook 1101.10. Patient Aligned Care Team (PACT) handbook. Washington, DC: Veterans Health Administration; 2014. p. 72.

    Google Scholar 

  20. Primary Care Management Module (PCMM) user manual. In: Affairs DoV, editor. Washington, DC; 2015. p. 197.

    Google Scholar 

  21. Gao J, Moran E, Almenoff PL, Render ML, Campbell J, Jha AK. Variations in efficiency and the relationship to quality of care in the veterans health system. Health Aff (Millwood). 2011;30(4):655–63.

    Article  PubMed  Google Scholar 

  22. Coleman DL, Moran E, Serfilippi D, Mulinski P, Rosenthal R, Gordon B, et al. Measuring physicians’ productivity in a veterans affairs medical center. Acad Med. 2003;78(7):682–9.

    Article  PubMed  Google Scholar 

  23. Bowen JL, Hirsh D, Aagaard E, Kaminetzky CP, Smith M, Hardman J, et al. Advancing educational continuity in primary care residencies: an opportunity for patient-centered medical homes. Acad Med. 2015;90(5):587–93.

    Article  PubMed  Google Scholar 

  24. VA Directive 2009-19. Ordering and reporting of test results. Washington, DC; 2009.

    Google Scholar 

  25. Long T, Uradu A, Castillo R, Brienza R. Addressing outpatient continuity for ambulatory training: a novel tool for longitudinal primary care sign out. Educ Health (Abingdon). 2016;29(1):51–5.

    Article  Google Scholar 

  26. Rodriguez HP, Rogers WH, Marshall RE, Safran DG. The effects of primary care physician visit continuity on patients’ experiences with care. J Gen Intern Med. 2007;22(6):787–93.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Rodriguez HP, Marshall RE, Rogers WH, Safran DG. Primary care physician visit continuity: a comparison of patient-reported and administratively derived measures. J Gen Intern Med. 2008;23(9):1499–502.

    Article  PubMed  PubMed Central  Google Scholar 

  28. United States. Agency for Healthcare Research and Quality., U.S. Preventive Services Task Force. U.S. Preventive Services Task Force evidence syntheses. AHRQ Publication. Rockville: Agency for Healthcare Research and Quality.

    Google Scholar 

  29. Bernard DM, Selden TM. Access to care among nonelderly veterans. Med Care. 2016;54(3):243–52.

    Article  PubMed  Google Scholar 

  30. Veterans and agent orange: update 2014. Washington, DC: National Academies Press (US); 2014.

    Google Scholar 

  31. US Veterans Affairs; 2015 [Veterans Diseases Associated with Agent Orange Exposure]. http://www.publichealth.va.gov/exposures/agentorange/conditions/index.asp

  32. Troyanskaya M, Pastorek NJ, Scheibel RS, Petersen NJ, McCulloch K, Wilde EA, et al. Combat exposure, PTSD symptoms, and cognition following blast-related traumatic brain injury in OEF/OIF/OND service members and Veterans. Mil Med. 2015;180(3):285–9.

    Article  PubMed  Google Scholar 

  33. Glaesmer H. Revealing the importance of military sexual trauma and its consequences. J Clin Psychiatry. 2014;75(10):e1188–9.

    Article  PubMed  Google Scholar 

  34. Conard PL, Young C, Hogan L, Armstrong ML. Encountering women veterans with military sexual trauma. Perspect Psychiatr Care. 2014;50(4):280–6.

    Article  PubMed  Google Scholar 

  35. Lee J, Sanders KM, Cox M. Honoring those who have served: how can health professionals provide optimal care for members of the military, veterans, and their families? Acad Med. 2014;89(9):1198–200.

    Article  PubMed  Google Scholar 

  36. Yano EM, Haskell S, Hayes P. Delivery of gender-sensitive comprehensive primary care to women veterans: implications for VA Patient Aligned Care Teams. J Gen Intern Med. 2014;29(Suppl 2):S703–7.

    Article  PubMed  Google Scholar 

  37. Bastian LA, Trentalange M, Murphy TE, Brandt C, Bean-Mayberry B, Maisel NC, et al. Association between women veterans’ experiences with VA outpatient health care and designation as a women’s health provider in primary care clinics. Womens Health Issues. 2014;24(6):605–12.

    Article  PubMed  PubMed Central  Google Scholar 

  38. VHA Handbook 1330.01. Health care services for women veterans. Washington, DC: Veterans Health Administration; 2010. p. 37.

    Google Scholar 

  39. VHA Directive 1330.01. Health care services for women veterans. Washington, DC: Veterans Health Administration; 2017. p. 34.

    Google Scholar 

  40. Bean-Mayberry B, Yano EM, Bayliss N, Navratil J, Weisman CS, Scholle SH. Federally funded comprehensive women’s health centers: leading innovation in women’s healthcare delivery. J Womens Health (Larchmt). 2007;16(9):1281–90.

    Article  Google Scholar 

  41. Reddy SM, Rose DE, Burgess JF Jr, Charns MP, Yano EM. The role of organizational factors in the provision of comprehensive women’s health in the veterans health administration. Womens Health Issues. 2016;26(6):648–55.

    Article  PubMed  Google Scholar 

  42. Yano EM, Bastian LA, Frayne SM, Howell AL, Lipson LR, McGlynn G, et al. Toward a VA Women’s Health Research Agenda: setting evidence-based priorities to improve the health and health care of women veterans. J Gen Intern Med. 2006;21(Suppl 3):S93–101.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hsieh E, Nunez-Smith M, Henrich JB. Needs and priorities in women’s health training: perspectives from an internal medicine residency program. J Womens Health (Larchmt). 2013;22(8):667–72.

    Article  Google Scholar 

  44. Yano EM. A partnered research initiative to accelerate implementation of comprehensive care for women veterans: the VA women’s health CREATE. Med Care. 2015;53(4 Suppl 1):S10–4.

    Article  PubMed  Google Scholar 

  45. Yano EM, Darling JE, Hamilton AB, Canelo I, Chuang E, Meredith LS, et al. Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans. Implement Sci. 2016;11(1):101.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Outpatient clinic practice management. In: Affairs DoV, editor. Washington, DC: VHA Publications; 2016. p. 20.

    Google Scholar 

  47. CPRS user manual. Washington, DC: Department of Veteran Affairs; July 2014. 488 p.

    Google Scholar 

  48. Computerized Patient Record System (CPRS) user guide: GUI version [Website]. Washington, DC: Office of Information & Technology (OI&T) Product Development, Department of Veteran Affairs; 2016 [updated March 2016. 509 p]. http://www.va.gov/vdl/documents/Clinical/Comp_Patient_Recrd_Sys_(CPRS)/cprsguium.pdf

  49. O’Hanlon C, Huang C, Sloss E, Anhang Price R, Hussey P, Farmer C, et al. Comparing VA and non-VA quality of care: a systematic review. J Gen Intern Med. 2017;32(1):105–21.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments and Disclaimer

The author appreciates the comments on an earlier draft by Roman Maher, C. Scott Smith, and Brown J. McCallum. Opinions expressed herein are the sole opinion of the author and not of the Department of Veterans Affairs.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rebekah A. Kaplowitz M.D., M.P.H. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Kaplowitz, R.A. (2018). Veterans Affairs Continuity Clinics. In: Lu, L., Barrette, EP., Noronha, C., Sobel, H., Tobin, D. (eds) Leading an Academic Medical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-68267-9_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-68267-9_23

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-68266-2

  • Online ISBN: 978-3-319-68267-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics