PACT ICU Model: Interprofessional Case Conferences for High-Risk/High-Need Patients
Physician, nurse practitioner trainees, medical center faculty, and clinic staff develop proactive, team-based, interprofessional care plans to address unmet chronic care needs for high-risk patients.
William Weppner is Codirector, Janet Willis is a Registered Nurse Care Manager and Associate Director of Nursing Education, and Jared Bernotski is an Education Systems Design Technician, all at the Center of Excellence in Primary Care Education at the Boise Veteran Affairs Medical Center in Idaho. Annette Gardner is the Assistant Professor, Department of Social and Behavioral Sciences Philip R. Lee Institute for Health Policy Studies, University of California in San Francisco. William Weppner also is an Associate Professor, Department of Medicine, University of Washington, Seattle. Correspondence: William Weppner (william.weppner@va.gov)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner,Frontline Medical Communications Inc., the US Government, or any of its agencies.
The Future
In stage 2 of the CoEPCE program, a multi-site trial of PACT ICU was completed to better understand which elements are critical to success, with the goal of facilitating broader exportability.5 The trial focused on 3 intertwined elements: structure, delivery, and evaluation. Using local implementation and the multisite trial, the most effective practices have been documented as part of an implementation kit, available at boisevacoe.org. The goal of the implementation kit is to facilitate step-by-step implementation of PACT ICU to other settings beyond the multisite study. Since the open-ended structure of PACT ICU enables accommodating different professions and specialties beyond the model’s Boise VAMC participants, it could be easily adapted to potentially support a variety of implementations elsewhere (Appendix).
Another opportunity for expansion is increased patient involvement. Currently, PACT ICU patients have the opportunity to review and ask questions about their multidisciplinary care plans before starting.
Patients know they have a team working on their behalf, but there are opportunities for more follow-up, including presenting patients who are seen by other providers outside the CoE, such as the attending physician who may also have challenging patients. Long-term goals include developing sustainable formats for supporting PACT ICU in nonacademic settings as part of “routine care” and evaluating the implementation and impact on patient care, satisfaction, and utilization.
