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Health Services Research & Development

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Partnered Evaluation Advances Whole Health System of Care across VA

June 9, 2021


Takeaway: Findings from this QUERI Partnered Evaluation led to the approval of an Executive Decision Memo in support of the modernization lanes of effort [see box] "Engaging Veterans in Lifelong Health, Well-Being, and Resilience," mandating the integration of Whole Health into mental health and primary care across the VA healthcare system. A report to VA’s Office of Patient-Centered Care and Cultural Transformation OPCC&CT on these findings also formed the foundation of VA's response to the CARA legislation requirements and was submitted by VA to the Chairman of the Senate Committee on Veterans’ Affairs.

In 2016, Congress passed the Comprehensive Addiction and Recovery Act (CARA) to address the national opioid epidemic. The bill specifically directs VA to address pain management for Veterans, and to conduct research on the implementation and impact of complementary and integrative health (CIH) and other approaches on the health and well-being of Veterans. In response, VA’s Office of Patient-Centered Care and Cultural Transformation formalized an approach to care called the Whole Health System of Care, incorporating patient-centered care and complementary and integrative health. In FY18, each Veterans Integrated Service Network (VISN) identified and funded a flagship site for a three-year pilot implementation of the Whole Health System (WHS) of Care (total of 18 flagship sites).

Modernization Lanes of Effort: VA’s Acting Under Secretary for Health, Dr. Richard Stone, has prioritized a set of large modernization initiatives (called Lanes of Effort, LOE) intended to streamline operations and focus attention on becoming a high-reliability organization. The Modernization Lanes of Effort support the need for aligned, unambiguous policies, and consistent policy implementation.

The three main components of the Whole Health System of Care include:

  1. The Pathway introduces Veterans to WH concepts and facilitates their identification of personal life and health goals – and the development of a personal health plan.
  2. Wellbeing Programs include a combination of CIH services, health coaching and support, as well as self-care and skill-building groups.
  3. Whole Health Clinical Care refers to the use of a WH paradigm for providing care in both allopathic and CIH settings.

All 143 VA medical centers are advancing the Whole Health approach at varying levels. Therefore, studying implementation strategies for integrating Whole Health throughout the current system of care is essential to further WH spread. Barbara Bokhour, PhD, co-Director of HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR), leads the VA QUERI Center for Evaluating Patient-Centered Care (EPCC-VA), which works to generate evidence for VA’s transformation to a Whole Health System of Care. Partnering with VA’s Office of Patient-Centered Care & Cultural Transformation, EPCC-VA conducted an evaluation of the 18 flagship sites.

Findings

The evaluation demonstrated that Veterans with chronic pain who used WHS services experienced a three-fold reduction in opioid use compared to those who did not. They also experienced improvements in experience of care, engagement in care, engagement in life, and perceived stress, indicating improvements in their overall wellbeing. Findings also showed that in the 18 flagship sites 31% of Veterans with chronic pain (up to 55% at 1 flagship) engaged in some Whole Health services; 26% of Veterans with chronic pain used complementary and integrative health therapies; and although many of these services were delivered in the community, an increasing proportion are being delivered within VA due to hiring of CIH providers within VA at the pilot sites. Further, employees with more involvement in Whole Health had higher rates of identifying their facility as the best place to work, in addition to having lower turnover, lower burnout, and greater motivation.

For the past 6 years, VA has been promoting patient-centered care through the implementation of a Whole Health approach. Whole Health (WH) is defined as an approach to health care that empowers and equips people to take charge of their health and well-being and live their life to the fullest.

Impacts

A report to OPCC&CT on these findings formed the foundation of VA's response to the CARA legislation requirements, culminating in the Congressionally Mandated report, titled “Pilot Program on the Integration of Complementary and Integrative Health and Well-Being Programs,” which was part of VA’s response to the legislation and was submitted by VA to the Chairman of the Senate Committee on Veterans’ Affairs. Findings also led to the approval of a VA Executive Decision Memo in support of the modernization LOE "Engaging Veterans in Lifelong Health, Well-Being, and Resilience," mandating the integration of Whole Health into Primary Care, Primary Care/Mental Health (PCMHI), and Mental Health across the VA healthcare system. EPCC's evaluation work has had widespread impact on the implementation of Whole Health at the VISN and site level, as their findings were presented to VA Central Office, VISN, and site leadership in support of Whole Health.

Partners

OPCC&CT: “The EPCC QUERI work on the WH flagships has created huge implementation momentum for our work. This is a great example of a true learning healthcare system.” Benjamin Kligler, MD, MPH, Executive Director, OPCC&CT.

Publications

Bokhour B, Haun J, Hyde J, Charns M, and Kligler B. Transforming the Veterans Affairs to a Whole Health System of Care: Time for action and research. Medical Care. April 2020;58(4):295-300.


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