How Primary Care Intensive Management Teams Coordinate Care for High-Risk Patients: A Multisite Evaluation Using the AHRQ Framework.

Abstract

Patients at high-risk for hospitalization require care coordination across their multiple conditions. Few studies, however, document performance of specific care coordination activities that together comprise care coordination for these patients. To evaluate whether and how five geographically diverse primary care intensive management teams delivered care coordination to high-risk patients, and to assess the construct validity of the Agency for Healthcare Research and Quality (AHRQ) care coordination framework for identifying and categorizing the identified care coordination elements. Participants included 29 primary care intensive management team members and 51 patients from five demonstration sites in five different states. Primary qualitative content analysis of semi-structured interviews from the Patient Aligned Care Team (PACT) Intensive Management (PIM) national Veterans Health Administration (VHA) demonstration project evaluation identified activities meeting a broad definition of care coordination. We conducted a secondary qualitative analysis of interviews containing care coordination content to test whether the identified activities could be categorized based on the AHRQ framework. Qualitative data validated the importance of all nine AHRQ domains as critical components of the care PIM delivered, with six of the nine AHRQ domains garnering mention by interviewees at each of the five sites. No activities proved challenging to classify into one of the nine AHRQ care coordination domains. PIM teams and their patients identified a wide variety of activities that could be classified as related to care coordination. Further secondary qualitative evaluation showed that the AHRQ framework successfully identified and classified the key activities that intensive management teams and their patients considered to be critical advantages of intensive primary care management of high-risk patients.