Veteran’s Health Administration (VHA)

Primary care services within the VA are provided by Patient Aligned Care Teams (PACT) which consist of a physician, physician assistant, or nurse practitioner paired with nursing, social work, mental health, pharmacy, and administrative support staff. The VA’s office of innovation has adopted PT in PACT as a best practice and is working towards embedding a physical therapist within primary care at each VA facility by 2025. The PACT PT diffusion team has developed several resources to facilitate this including an implementation guide and toolkit, a business case, educational handouts for key stakeholders, and monthly community of practice calls for ongoing development. Currently, there are 107 successful adoptions and 72 in progress across VHA.

While PACT PT models vary slightly across VHA to accommodate the needs unique to each site, all PACT PT programs share three common pillars:

  1. Co-location with primary care
  2. Same-day access to PT evaluation and treatment
  3. Close collaboration with all members of PACT team

Sites with full-time PACT PT coverage have adopted a ratio of one PACT PT for every 8-12 PACT teams to provide the right balance of same-day access and optimal clinic utilization. Many sites grew into full coverage over time by first allocating 2-3 slots on an outpatient PT’s schedule as dedicated same-day evaluation slots. Patients can be connected with PACT PT as a walk-in, a warm hand-off from a provider, or as a scheduled consult from nursing staff related to a secure message or call center inquiry. As frontline providers, PACT PTs routinely order imaging, place consults for specialty services, and recommend further diagnostics in collaboration with the PACT team. In order to protect same-day access, PACT PTs may pass patients to the outpatient PT clinic for follow-ups if they anticipate their plan of care will require more than 3-4 sessions. Within the VA system, the PACT PT also acts as a liaison between primary care and other physical medicine and rehabilitative services – an often overlooked yet valuable aspect of PACT PT that strengthens relationships across disciplines and optimizes referral pathways. If you’re interested in learning more about PACT PT initiatives within the VA and opportunities to build partnerships, please contact Evan Kelley and Ashley Cassel. 

Author: David Macchia

 

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