VISN 4 PACT Virtual Collaborative Model - Further Details

VISN 4 PACT Virtual Collaborative Model - Further Details

Virtual Learning Collaborative for PCMH Implementation – Online Appendix

VISN 4 PACT Virtual Collaborative Model - Further Details

Collaborative planning & oversight

The VISN 4 PACT Virtual Collaborative was conceived of by Dr. David Macpherson, Chief Medical Officer (CMO) for VISN 4. The Virtual Collaborative is led by Dr. Macpherson and primarily coordinated by Jennifer Skoko, Administrative Officer to the CMO, with continual input from the VISN 4 Virtual Collaborative Steering Committee, facility Primary Care leads, and facility PACT coaches.

Steering committee membership includes the VISN Primary Care Lead, the VISN Designated Learning Officer (education expert), past Learning Center faculty members, the Director and Associate Director of the VA Pittsburgh Geriatric Research Education and Clinical Center (GRECC), representatives from VA Employee Education Services (EES), and two CEPACT investigators (GT and AB). The committee began meeting weekly in September 2011 and then adjusted to a biweekly schedule in March 2012. The committee also regularly invites feedback and input from facility PACT coaches (see below) and from members of the VISN PACT Steering Committee.

Collaborative design – key components

  • Virtual learning sessions, which take place twice-monthly on Thursdays over the noon hour and are conducted via web-conferencing software (Microsoft Office Live Meeting). The day and time of the virtual sessions were chosen based on results of a learning needs assessment conducted by GRECC in the spring of 2011, which assessed the preferences of providers throughout the network; VISN 4 facility primary care leads gave their approval and agreed to block clinic schedules during the agreed-upon time. In addition to sessions devoted to PACT training, clinical sessions take place every 3rd session and are structured similarly to a traditional case study CME session. Attendance at PACT sessions is required for all team members, while clinical sessions are required for providers and optional for other members of the team.
  • On-site team meetings, which occur during “action periods” between virtual sessions. Facilities were instructed to give teams 1 hour of protected time to meet at least every other week but preferably on a weekly basis.
  • Team homework assignments, which were designed to promote hands-on application of material covered during the virtual sessions and were to be completed between sessions.
  • Additional supports, which include on-site PACT coaches; consultation with and up-to-date information from the Virtual Collaborative coordinator; and a SharePoint site housing recordings of virtual sessions and PACT-related tools and resources.


Dr. Macpherson (VISN 4 CMO) serves as principal faculty member and is joined by two faculty members from the original Learning Centers, national content experts, and frontline teams in leading the PACT sessions. Clinical sessions are typically presented by specialists in the field of interest from one of two university-affiliated VA facilities in VISN 4 (Pittsburgh or Philadelphia).

Coach identification & engagement

At the beginning of the Virtual Collaborative in January 2012, the VISN asked each facility to identify one or more coaches to help facilitate the Virtual Collaborative and PACT implementation at the local level. There is significant diversity among VISN 4’s ten facilities in terms of complexity and organizational culture, and many facilities already had some form of local PACT coaching in place prior to the Virtual Collaborative; for these reasons, Collaborative leadership did not feel it was necessary to closely prescribe or monitor the interaction between coaches and teams unless alerted to an issue. However, Virtual Collaborative participants were notified of the key contact(s) for their facility during a virtual session and via email, and they were also polled to assess whether those individuals were familiar to them.

Curriculum and training schedule

The general schedule for first 9 months of virtual sessions is included below. Topics covered during virtual sessions were selected by considering the following:

  • PACT Learning Center curriculum
  • Coach and participant feedback
  • Areas for improvement identified through surveys (EES, CEPACT, and VHA PACT Recognition)
  • Site performance on VHA PACT performance metrics (reviewed monthly)

Date / Title/Topic
1/5/2012 / PACT 101: PACT Learning Center Overview (part 1)
1/19/2012 / PACT 101: PACT Learning Center Overview (part 2)
2/2/2012 / Virtual Collaborative Introduction: Virtual Collaborative structure and process, VHA PACT metrics
2/16/2012 / Hospital Transitions: Improving transitions through post-discharge calls
3/1/2012 / Clinical session: Chronic Pain Management
3/15/2012 / Hot Spots: Identifying “hot spots” using VHA databases, registries, interventions
4/5/2012 / Advanced Access basics
4/19/2012 / Clinical session: Diabetes
5/3/2012 / Telephone Care as Substitute for Face to Face Care
6/7/2012 / Clinical session: Update in General Internal Medicine - The Top 10 Publications from 2011
6/21/2012 / Team-based Care
7/5/2012 / Where do we stand? Review of PACT implementation status
8/2/2012 / Team Presentations: 4 PACT teams present front line perspective
8/16/2012 / PACT Roles: Top of license and new roles
9/6/2012 / Clinical session: Pain Management - Identifying and caring for opioid misuse
9/20/2012 / Palliative Care