Integrating Personalized Care Planning into Primary Care: a Multiple-Case Study of Early Adopting Patient-Centered Medical Homes

• Published in: Journal of general internal medicine : JGIM Vol. 35; no. 2; pp. 428 - 436
• Main Authors: Bolton, Rendelle E., Bokhour, Barbara G., Hogan, Timothy P., Luger, Tana M., Ruben, Mollie, Fix, Gemmae M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2020; Springer Nature B.V
• Subjects: Case studies; Clinics; Content analysis; Critical components; Delivery of Health Care; Electronic health records; Electronic medical records; Health care; Health care facilities; Health services; Humans; Internal Medicine; Medicine; Medicine & Public Health; Original Research; Patient care planning; Patient Care Team; Patient-Centered Care; Patients; Primary care; Primary Health Care; Priorities; Qualitative analysis; Qualitative Research; United States; United States Department of Veterans Affairs; Workflow; United States; primary care; qualitative research; patient-centered care; Veterans
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-019-05418-4

Background
Personalized care planning is a patient-centered, 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.
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 in a manner that engages patients in treatment aligned with personal priorities. Primary care practices seeking to implement personalized care planning must go beyond simply asking patients a series of questions to establish a plan. They must also engage team members in plan development, communication, and dissemination.