The Patient Centered Team (PACT) intervention - How does it work and for whom?

Description

5% of the population spend 50% of all specialist care resources. These patients, often with complex long-term needs (CLNs), experience a fragmented care system ill prepared to provide for their needs. An extensive body of research indicates that critical elements of high-quality care for persons with CLNs include digital supported Person-centred, Integrated and Proactive care (PIP-care). Yet, outcome evaluations of PIP-care in the literature remain weak with a high proportion of negative studies.

The PIP-principles inspired the design of the Patient Centred Team (PACT). We started with PIP-care as our goal, and asked professionals to invent the care that would work in their context. PACT has subsequently demonstrated surprisingly consistent and strong results: “Compared with propensity score matched controls, the care process of frail multi-morbid elderly who received the PACT intervention had a reduced risk of high-level emergency care, increased use of low-level planned care, and substantially reduced mortality risk.”

To learn more from these very encouraging findings, we must now work backwards to get a detailed understanding of how PACT caused these positive effects, and who may benefit most. This knowledge is essential to improve the future care of patients with CLNs.

This study will also support a much needed care quality improvement for this costly and vulnerable group in both regional, national and international care contexts.

Goals

The overarching goal is:

To create a deeper understanding of how the successful PACT intervention works for persons with CLNs and identify those who benefit most.

This will be investigated by answering following research questions:

1. Why did the activities of the Patient Centred Team (PACT) reduce emergency care and mortality?
2. How were the elements of Person-centred, Integrated and Proactive (PIP) care documented and delivered?

Utility: Validation of widely recommended PIP-principles.

Method

This project will apply mixed methods, where we use quantitative and qualitative data as needed to answer the research questions.

Medical audit builds on the assumption that it is possible to formulate an idea of what is the desirable ideal clinical pathway, based on diagnosis specific evidence-based guidelines. However, for multimorbid patients the complexity of interactions between diagnosis, treatments and the person’s life and context, quickly make attempts to create combinatorial guidelines a quagmire of possibilities and uncertainties. We are developing another qualitative approach.

As the typical PACT patients are often cognitively impaired, too ill to manage interviews, or have already died in the follow-up period, we need to base our review on available written documentation from the electronic health care record (EHR) from GPs, the municipal health services and hospitals.

With this as our main information source, we will do a qualitative analysis of the available EHR documentation for a selection of PACT patients to identify the care processes for the patients. We aim to identify the challenges for each patient, both of medical and non-medical, contextual origin and how these challenges are managed in the healthcare system. We will specifically look for traces of the PIP-care model in which the PACT intervention is inspired of.

The qualitative evaluation will be followed by a qualitative comparative analysis of the PACT-group and their matched controls where we will look for characteristics and patterns that distinguish the two groups from one another.

Progress report:

We have secured access to the EHR documents for 10 controls who died within 7-30 days after baseline and their PACT-matches and have started our qualitative review of the PACT courses. The qualitative comparative analysis will be conducted after finishing the PACT audit.