Restructuring VA ambulatory care and medical education

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Abstract
The Veterans Health Administration ( VHA ) Western Region and associated medical schools formulated a set of recommendations for an improved ambulatory health care delivery system during a 1988 strategic planning conference . As a result , the Department of Veterans Affairs ( VA ) Medical Center in Sepulveda , California , initiated the Pilot ( now Primary ) Ambulatory Care and Education ( PACE ) program in 1990 to implement and evaluate a model program . The PACE program represents a significant departure from traditional VA and non-VA academic medical center care , shifting the focus of care from the inpatient to the outpatient setting . From its inception , the PACE program has used an interdisciplinary team approach with three independent global care firms . Each firm is interdisciplinary in composition , with a matrix management structure that expands role function and empowers team members . Emphasis is on managed primary care , stressing a biopsychosocial approach and cost-effective comprehensive care emphasizing prevention and health maintenance . Information management is provided through a network of personal computers that serve as a front end to the VHA Decentralized Hospital Computer Program ( DHCP ) mainframe . In addition to providing comprehensive and cost-effective care , the PACE program educates trainees in all health care disciplines , conducts research , and disseminates information about important procedures and outcomes . Undergraduate and graduate trainees from 11 health care disciplines rotate through the PACE program to learn an integrated approach to managed ambulatory care delivery . All trainees are involved in a problem-based approach to learning that emphasizes shared training experiences among health care disciplines . This paper describes the transitional phases of the PACE program ( strategic planning , reorganization , and quality improvement ) that are relevant for other institutions that are shifting to training programs emphasizing primary and ambulatory care .

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