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Physical Therapy Embedded Within PACT

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By embedding Physical Therapy into primary care, the Veteran can more readily access same day care for musculoskeletal, neurological, and pain complaints. Veterans are also able to receive some prosthetic items in a timelier manner improving function. Earlier access to PT offloads primary care providers, decreases referrals to specialty care and radiology improving efficiency and cost savings.

This innovation is scaling widely with the support of national stakeholders. See more scaling innovations.

Adoptions:

136 successful, 43 in-progress

Awards and Recognition:

Diffusion of Excellence Promising Practice, VHA Shark Tank Winner

Partners:

Clinical Orthotic and Prosthetic, Diffusion of Excellence, Office of Nursing Services, Office of Primary Care, Office of Rural Health, Physical Medicine and Rehabilitation, SimLearn, Veterans Experience Office, VHA Innovators Network

Contact Team

Overview

Problem

Veterans are often referred to physical therapy after seeing their Primary Care Provider, who may prescribe medications, order imaging and refer to one or more specialists for consultation (i.e. Neurology or Orthopedics) prior to or concurrently with referral to a physical therapist for an examination and treatment. This historical approach is known to incr ... See more

Solution

Embedding physical therapists in Primary Care facilitates same day examination and treatment for physical function and pain allowing earlier intervention and frequently avoiding unnecessary medications, imaging and specialty referrals while keeping Primary Care appointment times available for Veterans requiring medical care. The result for Veterans is impro ... See more

Results

1) Improve Veteran access by increasing same day access and decreased wait time for physical therapy appointments.
2) Promote best practice by embedding a physical therapist (musculoskeletal expert) in Primary Care with the goal of improving efficiency of care for musculoskeletal cases.
3) Improve access to specialty clinics and imaging by decreasing unn
... See more

Videos

3 minute video - Panel discussion regarding benefits and successes of Primary Care physical therapy.

Metrics

  • Reduced Veteran wait time for musculoskeletal examinations and treatments.
  • Decreased downstream costs - imaging, pain, specialty.
  • High Veteran satisfaction.
  • Improved Physical Therapy clinic utilization and productivity.
  • Reduced Community Care referrals for physical therapy.
  • Improved employee satisfaction.
  • Improved access to PT services and penetration rate.

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

AR: Conway VA Clinic (Conway, Arkansas)
  • Started adoption on 07/2024.
AR: El Dorado VA Clinic (El Dorado)
  • Started adoption on 07/2024.
AR: Fayetteville VA Medical Center (Fayetteville, Arkansas)
  • Started adoption on 05/2024.
AR: Hot Springs VA Clinic (Hot Springs, Arkansas)
  • Started adoption on 07/2024.
AR: Mena VA Clinic (Mena)
  • Started adoption on 07/2024.
AR: Mountain Home VA Clinic (Mountain Home, Arkansas)
  • Started adoption on 07/2024.
AR: Pine Bluff VA Clinic (Pine Bluff)
  • Started adoption on 07/2024.
AR: Russellville VA Clinic (Russellville)
  • Started adoption on 07/2024.
AR: Searcy VA Clinic (Searcy)
  • Started adoption on 07/2024.
AZ: Phoenix 32nd Street VA Clinic (Phoenix 32nd Street) AZ: Tucson VA Medical Center (Tucson)
  • Started adoption on 04/2024.
CA: Fairfield VA Clinic (Fairfield) CA: Los Angeles VA Clinic (Los Angeles)
  • Started adoption on 01/2023.
CA: Major General William H. Gourley VA-DoD Outpatient Clinic (Monterey) CA: McClellan VA Clinic (McClellan Park)
  • Started adoption on 08/2024.
CA: Palo Alto VA Medical Center (Palo Alto, California)
  • Started adoption on 01/2017.
CA: Redding VA Clinic (Redding)
  • Started adoption on 04/2023.
CA: West Los Angeles VA Medical Center (West Los Angeles)
  • Started adoption on 04/2022.
CO: Aurora VA Clinic (Aurora, Colorado) CO: Golden VA Clinic (Golden)
  • Started adoption on 01/2022.
CO: Grand Junction VA Medical Center (Grand Junction, Colorado) CO: Northern Colorado VA Clinic (Northern Colorado) CO: PFC Floyd K. Lindstrom Department of Veterans Affairs Clinic (Colorado Springs)
  • Started adoption on 10/2021.
CO: Rocky Mountain Regional VA Medical Center (Aurora Rocky Mountain)
  • Started adoption on 12/2023.
CO: Union Boulevard VA Clinic (Union Boulevard)
  • Started adoption on 04/2023.
CT: John J. McGuirk Department of Veterans Affairs Outpatient Clinic (New London)
  • Started adoption on 12/2023.
DE: Wilmington VA Medical Center (Wilmington, Delaware)
  • Started adoption on 07/2022.
FL: A.K. Baker VA Clinic (Middleburg)
  • Started adoption on 12/2021.
FL: Bruce W. Carter Department of Veterans Affairs Medical Center (Miami) FL: James A. Haley Veterans' Hospital (Tampa, Florida)
  • Started adoption on 01/2014, ended on 05/2014.
FL: Lake Baldwin VA Clinic (Lake Baldwin)
  • Started adoption on 11/2023.
FL: Leo C. Chase Jr. VA Clinic (Saint Augustine)
  • Started adoption on 12/2021.
FL: Orlando VA Medical Center (Orlando) FL: Pensacola VA Clinic (Pensacola)
  • Started adoption on 10/2023.
FL: William "Bill" Kling Department of Veterans Affairs Outpatient Clinic (Sunrise)
  • Started adoption on 08/2024.
GA: Charlie Norwood Department of Veterans Affairs Medical Center (Augusta Downtown) HI: Spark M. Matsunaga Department of Veterans Affairs Medical Center (Honolulu)
  • Started adoption on 05/2024.
IA: Carroll VA Clinic (Carroll) IA: Coralville VA Clinic (Coralville)
  • Started adoption on 08/2022.
IA: Des Moines VA Medical Center (Des Moines, Iowa) IA: Fort Dodge VA Clinic (Fort Dodge) IA: Iowa City VA Medical Center (Iowa City, Iowa) IA: Knoxville VA Clinic (Knoxville, Iowa) IA: Marshalltown VA Clinic (Marshalltown) IA: Mason City VA Clinic (Mason City) ID: Caldwell VA Clinic (Caldwell)
  • Started adoption on 07/2024.
ID: Pocatello VA Clinic (Pocatello)
  • Started adoption on 03/2023.
IL: Edward Hines Junior Hospital (Hines)
  • Started adoption on 05/2024.
IN: Jackie Walorski VA Clinic (Mishawaka)
  • Started adoption on 12/2023.
IN: Martinsville VA Clinic (Martinsville) KY: Franklin R. Sousley Campus (Lexington Leestown)
  • Started adoption on 11/2023.
LA: New Orleans VA Medical Center (New Orleans) MD: Perry Point VA Medical Center (Perry Point)
  • Started adoption on 07/2022.
MI: Bad Axe VA Clinic (Bad Axe)
  • Started adoption on 07/2024.
MI: Colonel Demas T. Craw VA Clinic (Traverse City)
  • Started adoption on 06/2024.
MI: Lieutenant Colonel Clement C. Van Wagoner Department of Veterans Affairs Clinic (Alpena)
  • Started adoption on 07/2023.
MI: Navy Corpsman Steve Andrews Department of Veterans Affairs Health Care Clinic (Gaylord)
  • Started adoption on 03/2023.
MI: Wyoming VA Clinic (Wyoming)
  • Started adoption on 10/2022.
MN: Brainerd VA Clinic (Brainerd) MN: Hibbing VA Clinic (Hibbing) MN: Lyle C. Pearson Community Based Outpatient Clinic (Mankato)
  • Started adoption on 03/2023.
MN: Maplewood VA Clinic (Maplewood) MN: Max J. Beilke Department of Veterans Affairs Outpatient Clinic (Alexandria, Minnesota) MN: Minneapolis VA Medical Center (Minneapolis, Minnesota)
  • Started adoption on 01/2018.
MN: Rochester VA Clinic (Rochester, Minnesota) MN: Shakopee VA Clinic (Shakopee) MN: St. Cloud VA Medical Center (St. Cloud) MO: Harry S. Truman Memorial Veterans' Hospital (Columbia, Missouri)
  • Started adoption on 01/2018, ended on 06/2018.
MS: Biloxi VA Medical Center (Biloxi)
  • Started adoption on 10/2023.
MT: Benjamin Charles Steele VA Clinic (Billings Majestic Lane) MT: David J. Thatcher VA Clinic (Missoula)
  • Started adoption on 07/2023.
MT: Fort Harrison VA Medical Center (Fort Harrison) NC: Charles George Department of Veterans Affairs Medical Center (Asheville)
  • Started adoption on 05/2023.
NC: Clayton-East Raleigh VA Clinic (Clayton East Raleigh)
  • Started adoption on 07/2023.
NC: Croasdaile VA Clinic (Croasdaile )
  • Started adoption on 05/2024.
NC: Durham VA Medical Center (Durham)
  • Started adoption on 02/2024.
NC: Greenville VA Clinic (Greenville, North Carolina)
  • Started adoption on 01/2024.
NC: Morehead City VA Clinic (Morehead City)
  • Started adoption on 09/2023.
NC: Raleigh VA Clinic (Raleigh, North Carolina)
  • Started adoption on 01/2018, ended on 06/2019.
NC: W.G. (Bill) Hefner Salisbury Department of Veterans Affairs Medical Center (Salisbury)
  • Started adoption on 04/2024.
NE: Lincoln VA Clinic (Lincoln, Nebraska)
  • Started adoption on 10/2023.
NE: Omaha VA Medical Center (Omaha, Nebraska) NH: Manchester VA Medical Center (Manchester) NH: Somersworth VA Clinic (Somersworth)
  • Started adoption on 08/2022.
NJ: Burlington County VA Clinic (Burlington County)
  • Started adoption on 12/2022.
NJ: Hamilton VA Clinic (Hamilton, New Jersey)
  • Started adoption on 08/2024.
NV: Ioannis A. Lougaris Veterans' Administration Medical Center (Reno)
  • Started adoption on 11/2023.
NV: Reno East VA Clinic (Reno East)
  • Started adoption on 10/2023.
NY: Bath VA Medical Center (Bath)
  • Started adoption on 07/2023.
NY: Buffalo VA Clinic (Buffalo Main Street) NY: Buffalo VA Medical Center (Buffalo, New York) NY: Canandaigua VA Medical Center (Canandaigua)
  • Started adoption on 05/2024.
NY: Catskill VA Clinic (Catskill)
  • Started adoption on 04/2024.
NY: Donald J. Mitchell Department of Veterans Affairs Outpatient Clinic (Rome, New York)
  • Started adoption on 03/2024.
NY: East Meadow VA Clinic (East Meadow)
  • Started adoption on 08/2023.
NY: Rochester Calkins VA Clinic (Rochester Calkins)
  • Started adoption on 08/2022.
NY: Syracuse VA Medical Center (Syracuse)
  • Started adoption on 12/2022.
OH: Cincinnati VA Medical Center (Cincinnati, Ohio)
  • Started adoption on 01/2022.
OH: Toledo VA Clinic (Toledo)
  • Started adoption on 11/2023.
OK: Ernest Childers Department of Veterans Affairs Outpatient Clinic (Tulsa)
  • Started adoption on 01/2022.
OK: Jack C. Montgomery Department of Veterans Affairs Medical Center (Muskogee, Oklahoma)
  • Started adoption on 01/2022.
OK: Oklahoma City VA Medical Center (Oklahoma City) OK: South Oklahoma City VA Clinic (South Oklahoma City)
  • Started adoption on 03/2022.
PA: Coatesville VA Medical Center (Coatesville) PA: H. John Heinz III Department of Veterans Affairs Medical Center (Heinz)
  • Started adoption on 10/2022.
PA: James E. Van Zandt Veterans' Administration Medical Center (Altoona)
  • Started adoption on 04/2023.
PA: Monroeville VA Clinic (Monroeville)
  • Started adoption on 08/2023.
PA: Pittsburgh VA Medical Center-University Drive (Pittsburgh)
  • Started adoption on 01/2018, ended on 05/2018.
PA: Victor J. Saracini Department of Veterans Affairs Outpatient Clinic (Horsham)
  • Started adoption on 09/2022.
PR: San Juan VA Medical Center (San Juan)
  • Started adoption on 01/2017, ended on 06/2018.
SD: Fort Meade VA Medical Center (Fort Meade, South Dakota) SD: Rapid City VA Clinic (Rapid City) SD: Royal C. Johnson Veterans' Memorial Hospital (Sioux Falls) SD: Sioux City VA Clinic (Sioux City)
  • Started adoption on 10/2023.
TN: Alvin C. York Veterans' Administration Medical Center (Murfreesboro) TN: Charlotte Avenue VA Clinic (Charlotte Avenue)
  • Started adoption on 02/2023.
TN: Chattanooga VA Clinic (Chattanooga)
  • Started adoption on 08/2023.
TN: Clarksville VA Clinic (Clarksville) TN: International Plaza VA Clinic (International Plaza)
  • Started adoption on 10/2023.
TN: James H. Quillen Department of Veterans Affairs Medical Center (Mountain Home, Tennessee)
  • Started adoption on 02/2023.
TX: Audie L. Murphy Memorial Veterans' Hospital (San Antonio, Texas) TX: New Braunfels VA Clinic (New Braunfels)
  • Started adoption on 03/2023.
UT: Ogden VA Clinic (Ogden)
  • Started adoption on 05/2022.
UT: Orem VA Clinic (Orem)
  • Started adoption on 05/2022.
UT: St. George VA Clinic (St. George)
  • Started adoption on 04/2023.
VA: Hampton VA Medical Center (Hampton)
  • Started adoption on 08/2024.
VT: Burlington Lakeside VA Clinic (Burlington Lakeside)
  • Started adoption on 01/2023.
VT: White River Junction VA Medical Center (White River Junction)
  • Started adoption on 01/2023.
WA: Vancouver VA Medical Center (Vancouver)
  • Started adoption on 05/2023.
WI: Madison West VA Clinic (Madison West) WI: Rice Lake VA Clinic (Rice Lake)
  • Started adoption on 11/2022.
WI: Twin Ports VA Clinic (Twin Ports) WI: William S. Middleton Memorial Veterans' Hospital (Madison)
  • Started adoption on 01/2018, ended on 01/2019.
WV: Louis A. Johnson Veterans' Administration Medical Center (Clarksburg)
  • Started adoption on 10/2023.
WY: Cheyenne VA Medical Center (Cheyenne) WY: Sheridan VA Medical Center (Sheridan)

AL: Birmingham VA Medical Center (Birmingham, Alabama)
  • Started adoption on 08/2024.
CA: Chico VA Clinic (Chico)
  • Started adoption on 04/2023.
CA: Jerry L. Pettis Memorial Veterans' Hospital (Loma Linda, California)
  • Started adoption on 08/2024.
CA: Tibor Rubin VA Medical Center (Long Beach)
  • Started adoption on 08/2024.
GA: Joseph Maxwell Cleland Atlanta VA Medical Center (Atlanta, Georgia)
  • Started adoption on 04/2024.
GA: Valdosta VA Clinic (Valdosta)
  • Started adoption on 05/2024.
ID: Boise VA Medical Center (Boise)
  • Started adoption on 05/2024.
ID: Mountain Home VA Clinic (Mountain Home, Idaho)
  • Started adoption on 07/2024.
IL: Danville VA Medical Center (Danville, Illinois)
  • Started adoption on 07/2024.
IL: Jesse Brown Department of Veterans Affairs Medical Center (Chicago, Illinois)
  • Started adoption on 08/2024.
IN: Hoosier VA Clinic (Hoosier)
  • Started adoption on 03/2024.
KS: Robert J. Dole Department of Veterans Affairs Medical and Regional Office Center (Wichita)
  • Started adoption on 03/2023.
KY: Florence VA Clinic (Florence, Kentucky)
  • Started adoption on 07/2024.
MA: Edith Nourse Rogers Memorial Veterans' Hospital (Bedford)
  • Started adoption on 04/2024.
MA: Edward P. Boland Department of Veterans Affairs Medical Center (Central Western Massachusetts)
  • Started adoption on 08/2024.
MD: Baltimore VA Medical Center (Baltimore)
  • Started adoption on 05/2024.
MI: Aleda E. Lutz Department of Veterans Affairs Medical Center (Saginaw, Michigan) MI: John D. Dingell Department of Veterans Affairs Medical Center (Detroit)
  • Started adoption on 03/2024.
MO: John J. Cochran Veterans Hospital (St. Louis John Cochran)
  • Started adoption on 03/2024.
MO: John J. Pershing Veterans' Administration Medical Center (Poplar Bluff)
  • Started adoption on 03/2024.
MO: Kansas City VA Medical Center (Kansas City, Missouri)
  • Started adoption on 08/2024.
MO: St. Louis VA Medical Center-Jefferson Barracks (St. Louis Jefferson Barracks)
  • Started adoption on 08/2024.
NC: Fayetteville VA Medical Center (Fayetteville, North Carolina) NC: Kernersville VA Clinic (Kernersville)
  • Started adoption on 04/2024.
NC: North Charlotte VA Clinic (North Charlotte)
  • Started adoption on 08/2024.
ND: Fargo VA Medical Center (Fargo) NV: North Las Vegas VA Medical Center (North Las Vegas)
  • Started adoption on 08/2024.
NY: James J. Peters Department of Veterans Affairs Medical Center (Bronx)
  • Started adoption on 05/2024.
NY: Northport VA Medical Center (Northport) OH: Dayton VA Medical Center (Dayton)
  • Started adoption on 04/2024.
OH: Louis Stokes Cleveland Department of Veterans Affairs Medical Center (Cleveland, Ohio)
  • Started adoption on 08/2024.
OH: New Philadelphia VA Clinic (New Philadelphia)
  • Started adoption on 05/2024.
OR: Portland VA Medical Center (Portland, Oregon)
  • Started adoption on 05/2023.
OR: Roseburg VA Medical Center (Roseburg)
  • Started adoption on 08/2024.
OR: White City VA Medical Center (White City)
  • Started adoption on 08/2024.
PA: Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center (Philadelphia, Pennsylvania) PA: Wilkes-Barre VA Medical Center (Wilkes-Barre) TN: Nashville VA Medical Center (Nashville) TX: Brownsville VA Clinic (Brownsville) TX: Corpus Christi West Point VA Clinic (Corpus Christi West Point) TX: Dallas VA Medical Center (Dallas)
  • Started adoption on 03/2024.
TX: Lubbock VA Clinic (Lubbock)
  • Started adoption on 07/2024.
VA: Richmond VA Medical Center (Richmond, Virginia)
  • Started adoption on 08/2024.

There are no unsuccessful adoptions for this innovation.

Multimedia

Images

Primary Care physical therapy is an interdisciplinary program with high employee satisfaction.

Veterans receive immediate care for common neuromuscular conditions such as positional vertigo (BPPV).

Veterans receive education in strategies to self treat their musculoskeletal conditions immediately in Primary Care.

Veterans may receive common durable medical equipment (DME) such as front wheeled walkers, single point canes and rollators in Primary Care.

Videos

12 minute video - Veteran, RN, MD, and PT discussing benefits of PACT PT at the Orlando VA.

Implementation

Timeline

  • 3-6 months.
    Resource Allocation 1 month.
    Clinic Set Up/Labor Mapping/Operational Planning with Primary Care 2 months.
    Rapport building/process improvement 1-3 months.

Departments

  • Extended care and rehabilitation
  • Radiology
  • Physical therapy, occupational therapy and kinesiothology
  • Primary care
  • Rehabilitation and prosthetics

Core Resources

Resource type Resource description
PEOPLE
  • Please refer to implementation guide for more details.

Files

Optional Resources

Files

Risks and mitigations

Risk Mitigation
Dedicated space within Primary Care Clinics A standard patient exam room is adequate to provide services. One PT FTE to 4 PACT teams (12-16 providers) has been demonstrated to be adequate.

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

VA User (Nurse Practitioner) Innovation adopter posted

TN Valley (TVHS) started this perhaps a year or so ago. We have Dr. Michael Morris here at Charlotte Ave Clinic, a CBOC in Nashville, TN. The program is excellent and Dr. Morris is truly one of the BEST PTs there is. His professionalism and skillset cannot be matched. He is a perfect fit for this Veteran population and an asset to our PACT and TVHS. ALL VAs deserve PACT PT and a Dr. Morris.

VA User (Physical Therapist) posted

Check out our updated marketplace site with links to the most up to date resources available. Contact us with any questions or if your site would like to enroll in to our next PACT Cohort group scheduled to kickoff Spring 2024.

VA User (Physical Therapist) posted

I am a new primary care physical therapist in a facility that is adopting this in the clinic. I can not access the resources provided above is there a way that these could be emailed?

VA User (RN) Innovation owner posted

I am CBOC Manager that wants to expand my services in my area

1
VA User (Physical Therapist) Innovation adopter posted

Boise VA Medical Center completed trial of this practice in 2019, implementing at main VA facility and Caldwell CBOC in 2021.

1
VA User (Physical Therapy Resident) posted

Really interested in gaining access to these resources. It appears the links aren't active at this time, could they be sent to jonathan.little1@va.gov Thank you!

VA User (Physical therapist) posted

I can't open the first link fact sheet for embedding PT in Primary Care but the others work.

VA User (Physical Therapist) posted

I am interested in implementing this practice at our facility, but I cannot access support material for some reason. It shows a bunch of code and access denied. Any help would be appreciated!

VA User (Physical Therapist) Innovation adopter posted

We have had this running (1/2 FTE) at Battle Creek, MI VA for roughly 18 months!

Page looks great, thanks for the info.

VA User (Physical Therapist) Innovation adopter posted

Here at the Pittsburgh VA we have been implementing this into our clinical practice for the past year.

1
VA User (V23 REC ICC Rehabilitation and SCI/D Program Manger) Innovation owner posted

Please contact any of us for additional support in implementation.

Email

Email with questions about this innovation.

About

Origin story

Primary Care PT started in Tampa, FL VA in 2008. VA Central Iowa was recognized in the 2017 Best Care Everywhere as a highlighted practice by embedding PT into PACT. VISN 23 strategic initiative in 2018 embedded PTs in PACT throughout VISN 23. PACT PT was a DOE Shark Tank winner in 2020. In 2021, PACT PT partnered with DOE and the program was successfull ... Primary Care PT started in Tampa, FL VA in 2008. VA Central Iowa was recognized in the 2017 Best Care Everywhere as a highlighted practice by embedding PT into PACT. VISN 23 strategic initiative in 2018 embedded PTs in PACT throughout VISN 23. PACT PT was a DOE Shark Tank winner in 2020. In 2021, PACT PT partnered with DOE and the program was successfully piloted at Augusta and New Orleans VAMCs. PACT PT was deemed a promising national diffusion practice in 2022. 40 sites successfully participated in the first cohort group in 2022-23 and are now fully implemented. 60 additional sites are currently in cohort 2 working towards implementation. Cohort 3 will launch in Spring 2023. Please email VHACIHPACTPTDiffusionteam@va.gov for more information.

Original team

Brandon Peterson

PT Sioux Falls VAMC

Ashley Cassel

PT Minneapolis VAMC

Chris Rowedder

PT Central Iowa VAMC

Amanda Simone

PT, VISN 23 Rehabilitation and Extended Care Program Manager

Evan Kelley

PT, Associate Chief Sensory and Physical Rehabilitation Service