San Francisco VA Health Care System
Education in Patient Aligned Care Teams (EdPACT)
Center of Excellence in Primary Care Education (CoEPCE)
The mission of the VA CoEPCE is to better prepare health care professionals to become future leaders in patient-centered, team-based care, to ensure that our nation's Veterans receive top quality health care in the years ahead.
The SFVA CoEPCE was funded for five years in 2011 as one of five centers within the VA health care system. Two more centers were added in 2015. In collaboration with the University of California, San Francisco (UCSF) Schools of Medicine and Nursing (SOM, SON), the EdPACT program facilitated implementation of Patient Aligned Care Teams--the VA's version of the patient-centered medical home--at the SFVA, and transformed primary care education.
In 2015, the CoEPCE was deemed an integral part of the Medical Center, and funding was secured through a permanent budget line item for future years. The VA's vision is to replicate key components of the CoEPCE programs in VA primary care clinics nationwide.
The CoEPCE Structure:
- Trains nurse practitioner students and internal medicine residents together, alongside pharmacy, psychology, registered dietician, optometry, podiatry, and social worker trainees.
- Each interdisciplinary team has its own panel of patients for one year.
- Daily 'huddles' allow each team to raise healthcare challenges within the group, to be solved from a multidisciplinary perspective with coaching from interprofessional faculty. Teams also include clinic staff RNs, LVNs, and clerical associates.
- This model meets the complex needs of the VA's patient population.
- Focuses on teambuilding, interprofessional collaboration, and communication.
- Includes shared decision making, motivational interviewing, patient communication, systems and performance improvement, team-based care, interprofessional communication, panel management, and many other topics that complement the rigorous clinical training by interprofessional faculty.
- Is an example of workplace learning, meaning that learners gain knowledge and skills through real-time patient care activities, case-based conferences, and feedback from faculty, staff, and peers.
Four Educational Domains:
- Interprofessional Collaboration: huddles, conflict resolution, team building, team communication.
- Patient-Centered Communication and Shared Decision Making: patient-provider communication, agenda setting, motivational interviewing, collaborative patient visits.
- Sustained Relationships: telephone medicine, home visits, palliative care, secure messaging.
- Performance Improvement: interprofessional team training and projects focused on quality improvement of patient care and systems delivery.
- Improve patient care and safety
- Improve learners' experience and the effectiveness of outpatient primary care training
- Improve patient and provider satisfaction
- Attract more clinicians to primary care
- Incorporate learners into Patient-Aligned Care Teams (in the medical home model)
- Develop cohesive teams that have a mutual understanding of the work and share the work accordingly
- Improve communication and organization, within and among the teams
- Increase learners' opportunities for learning and development
Methods to Achieve Goals and Objectives:
- Partner UCSF MD residents and NP students and residents and embed them in clinical care teams along with learners from pharmacy, psychology, dietetics, and social work. These teams stay together for up to 2 years.
- Huddling: Learn more about Huddles here.
- Implement evidence-based communication tools and strategies from TeamSTEPPS: Check-backs (close-looped communication to ensure information has been understood); Briefs; Debriefs; and ISBAR (situation, background, assessment, recommendation and request
- Facilitate and encourage team bonding: Half-day retreats every year; daily check-ins in huddle sessions; and Happy hour
- Teams engage in Quality Improvement Projects, Root Cause Analyses and Patient Safety Journal Clubs
- Formal mentoring by faculty
- Clinical precepting
- Daily teaching seminars
- Formal panel management
Read more about Patient Aligned Care Teams in the document, "Academic PACT: A blueprint for primary care redesign in academic practice settings," available here.
- How to Huddle
- Huddle Coaching
- IAHC Webinar Series
- Primary Care Process: EdPACT
- Training Primary Care Nurse Practitioners and Physicians
- Science of Caring
- Huddle Implementation Toolkit
The EdPACT COE exists at the main San Francisco VA Health Care System (Fort Miley), 4150 Clement St., San Francisco, and at two Bay Area Community-Based Outpatient Clinics (CBOCs) in Downtown San Francisco and San Bruno.