Please select the eligibility criteria that correspond to the clinical trial below.
Title: Implementation of VA Womens Health Patient Aligned Care Teams WH-PACTs
Brief Summary: VA has undertaken a major initiative to transform care through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home (PCMH) concept, PACT aims to improve access, continuity, coordination and comprehensiveness using team-based care that is patient-driven and patient-centered. However, how VA should adapt PACT to meet the needs of special populations, such as women Veterans, is yet to be worked out. The main goal of this study was to develop and test an evidence-based quality improvement (EBQI) approach to adapting and implementing PACT for women Veterans, incorporating comprehensive women's health care in gender-sensitive care environments, thereby accelerating achievement of PACT tenets for women Veterans and reducing persistent gender disparities in VA quality of care.


Options:
A: Inclusion Criteria:

* Participant families will

  1. have received low-income assistance either in the form of

     1. Alberta Works Income Support
     2. Alberta Child Health Benefits,
     3. Alberta Works Adult Health Benefits
     4. participating in City of Edmonton Leisure Access Program
     5. living in Capital Region Housing
  2. have a child or children between 0 and 12 years of age
  3. reside in city of Edmonton
  4. be able to provide signed consent

Exclusion Criteria:

* Potential study participants will be excluded if they refuse to give informed consent to be interviewed
* are unable to read and write English and an appropriate translator is not available
* have plans to move outside the region
* are unwilling to participate for the entire follow-up period
B: Inclusion Criteria:

* Must be staff or clinicians (including physicians, nurse practitioners, and physician assistants) in an enrolled primary care practice
* Primary care practices must be family medicine or general internal medicine practices with a maximum of ten lead clinicians
* Primary care practices must be either independent or, if part of a larger organization, demonstrate on careful screening that they do not receive significant quality improvement support from the larger organization

Exclusion Criteria:

* Primary care practices with more than 10 lead clinicians
* Non-independent primary care practices that receive significant quality improvement support from their system or organization
* Clinicians and staff who do not speak or read English
C: Inclusion Criteria:

* child between the ages of 7-10 who lives with the target adult at least 50% of the time
* parent/guardian must be the primary-meal preparing parent/guardian

Exclusion Criteria:

* planning to move out of the area in the next 6 months
* medical condition that would prevent family from participating in group sessions
D: Inclusion Criteria:

Facility inclusion criteria:

* VA medical center (VAMC)
* Located in a VISN that has 3 or more VAMCs
* Membership in the Women's Health Practice Based Research Network (PBRN)

Key Stakeholder (interviews) inclusion criteria:

* VISN and VAMC leaders, VAMC primary care/PACT directors, VAMC women's health medical directors, Women Veteran Program Managers (VISN and VAMC), VISN representatives in mental health, health information technology/informatics, quality improvement/system redesign, at least one Nurse Executive (VISN or VAMC)
* Intervention and control VAMCs

Provider (surveys and interviews) inclusion criteria:

* Primary care providers (medical doctor \[MD\], doctor of osteopathy \[DO\], nurse practitioner \[NP\], physician assistant \[PA\]) who have seen 1+ women Veterans in the past year
* Teamlet primary care provider interviews (MD, DO, NP, PA) at intervention VAMCs
* Surveys of primary care providers (MD, DO, NP, PA) at intervention and control VAMCs
* Surveys of larger primary care/PACT team members (e.g., clinical pharmacists, health coaches)

Staff (surveys and interviews) inclusion criteria:

* Primary care/PACT clinical staff (non-providers) in primary care/PACT teams/teamlets that have seen 1+ women Veterans in the past year
* Teamlet member interviews at Intervention VAMCs

Patient inclusion criteria:

- Women Veterans seen in participating VAMCs with 3+ primary care visits in general primary care and/or women's health clinics in the past year

Exclusion Criteria:

Facility exclusion criteria:

* VA facilities that are not VAMCs (e.g., community-based outpatient clinics or CBOCs)
* VAMCs in VISNs with fewer than 3 VAMCs
* VAMCs that are not members of the WH PBRN

Key Stakeholder (interviews) exclusion criteria:

- Stakeholders outside of the participating VISNs (1, 4, 12, 23) and VAMCs (see study sites)

Provider (surveys and interviews) exclusion criteria:

* VA providers who do not deliver primary care in participating VAMCs
* VA primary care providers who have not seen or do not see women Veteran patients for primary care delivery at a participating VAMC
* Teamlet providers at control VAMCs will not be interviewed

Staff (surveys and interviews) exclusion criteria:

* Primary care clinical staff not participating in PACT (e.g., assigned to primary care rolls but not actually associated with primary care/PACT direct patient care delivery)
* Primary care/PACT clinical staff at control VAMCs will not be interviewed

Patient exclusion criteria:

* Women Veterans who do not use the VA for their health care or for their primary care needs
* Women Veterans with fewer than 3 VA primary care visits in the prior year and therefore not exposed to PACT or WH PACT
* Women Veterans with terminal illness and/or poor prognosis or other health concerns for whom enrollment and survey participation would prove an inappropriate burden

Answer: D