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Health System Redesign

OHSU and VA General Internists are conducting research to impact and transform the delivery of primary care medicine.

Selected Research Projects

Patient Aligned Care Team (PACT) Initiative Demonstration Lab
PI: David Hickam, MD, MPH Co-Is:  Christina Nicolaidis, MD MPH,  Anais Tuepker, PhD
Funding: Department of Veterans Affairs
Beginning in 2010, the Department of Veterans Affairs (VA) initiated the Patient Aligned Care Team (PACT), a team-based model of care, with an initial emphasis on the transformation of primary care delivery. This 5 year, mixed methods observational study will evaluate the implementation of the PACT model and associated clinical outcomes in Oregon VA clinics.

Care Transitions Innovation (C-TraIn)
PI:  Honora Englander MD Co-PI:  Devan Kansagara MD, MCR
The Care Transitions Innovation is a multi-component hospital-to-home transitional care intervention for uninsured and low-income publicly insured adults.  The investigators have completed a randomized controlled trial of the utilization and quality of care effects of the intervention:  results are expected to be reported in fall 2012. 

Selected Papers

  1. Englander H and Kansagara D.  Planning and designing the Care Transitions Innovation (C-Train) for Uninsured and Medicaid Patients.  J Hosp Med.  In press.
  2. Kansagara D, Ramsay R, Labby D et al.  A post-discharge intervention in vulnerable, chronically ill patients. J Hosp Med.  7(2):  124-130, 2012.
  3. Kansagara D, Englander H, Salanitro A et al.  Risk Prediction Models for Hospital Readmission:  A systematic review.  JAMA.  306(15):  1688-1698, 2011.
  4. Nicolaidis, C., Touhouliotis, V.  "Addressing intimate partner violence in primary care:  lessons from chronic illness management".  Violence and Victims. 2006;21(1)101-116. (PMID:16494136) 

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