Enhancing Veterans’ Whole Health
April 29, 2025
Takeaway: HSR and QUERI investigators have worked with partners such as VA’s Office of Patient-Centered Care and Cultural Transformation to support VA’s initiatives to care for Veterans through a Whole Health lens. Impacts include establishing and rolling out the Well-Being Signs measure of Whole Health, providing scientific evidence that has informed VA’s response to legislative mandates, and demonstrating improved aspects of health among Veterans who engaged with VA’s Whole Health services.
Background
“Whole health” in healthcare looks beyond symptoms and disease to also align care with patients’ goals, improve well-being, and consider social determinants of health such as economic and housing stability, loneliness, discrimination, and healthcare access, which can affect health.
VA’s Health Systems Research (HSR) and Quality Enhancement Research Initiative (QUERI) provide scientific evidence to support VA’s transformation to a Whole Health System of care and inform VA’s Whole Health treatments, programs, and policies. The relevance of HSR and QUERI Whole Health projects is optimized through partnerships with VA’s Office of Patient-Centered Care and Cultural Transformation (OPCC&CT), the National Center for PTSD, VA’s Offices of Rural Health, Mental Health, Suicide Prevention, and Geriatrics and Extended Care, as well as others, including specialty care services such as cardiology and pulmonary medicine.
Considering the Well-Being of the Whole Person in Healthcare. A December 2024 Medical Care supplement described HSR research and strategies for measuring well-being and whole person outcomes in healthcare. The supplement includes conclusions from an HSR State-of-the-Art (SOTA) conference on Whole Health that detailed how, through measurement of well-being, healthcare systems can improve care delivery and patient health by addressing not only disease, but also what matters most to patients.
HSR and QUERI Impacts on Policy, Practice, and Patients
- Investigators from the National Center for PTSD and HSR’s Center for Health Optimization and Implementation Research (CHOIR) worked with VA leaders to develop and validate a well-being measure for use throughout VA [1] and partnered with OPCC&CT to roll out the Well-Being Signs measure of Whole Health to gauge Veterans’ ability to engage in the roles and activities that matter most to them. The measure has been administered more than 35,705 times in 456 unique clinics within 120 facilities across VA and is part of a strategy for assessing Veteran well-being that has been adopted systemwide by VA.
- Twelve years of partnered evaluation conducted by QUERI’s Center for Evaluating Patient-Centered Care (EPCC-VA), in partnership with OPCC&CT,[2] has contributed to the evidence that supports implementation of VA’s Whole Health System.
- Findings from a three-year partnered evaluation across 18 flagship sites informed VA Directive 1445: Whole Health System (2023), which mandated the integration of Whole Health across VA. The evaluation also contributed to VA’s response to the Comprehensive Addiction and Recovery Act (CARA), which requires 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.
- EPCC-VA’s findings, which demonstrated the benefit of Whole Health for Veterans and identified related barriers and facilitators, were cited throughout a 2023 National Academies of Science, Engineering and Medicine report.
- EPCC-VA’s analysis of national administrative data found that Veterans who engaged in Health and Wellness Coaching in FY2023 experienced increased participation in other services that are valuable for overall health (e.g., CIH, physical therapy, mental health).
- Also as part of EPCC-VA, HSR’s Seattle-Denver Center of Innovation (COIN) for Veteran-Centered & Value Driven Care found that among VA users who engaged with Whole Health services, the number of Veterans who achieved optimal blood glucose control increased by 5% within the study period compared to only a 2% increase among non-users over the same period.[3] Multiple briefings of the findings were provided to senior leaders across VA in FY2024 to guide VA’s Whole Health implementation efforts.
- In a separate study, the Seattle-Denver COIN, in partnership with OPCC&CT, found that Whole Health participation was associated with a 33% increase in Veterans who reported receiving support related to their health goals, a 20% increase in Veterans who reported that their providers were actively helping them care for their health, and a 21% increase in overall satisfaction among women Veterans.[4]
- In another OPCC&CT-partnered evaluation, researchers from the Seattle-Denver COIN found that Veterans suffering from chronic pain who engaged in Whole Health utilized 42% fewer invasive pain treatments at three months compared with similar Veterans who received conventional care. A difference was still present at 18 months, with Whole Health users undergoing 22% fewer invasive pain treatments. Veterans who engaged in CIH but no other Whole Health services also utilized fewer treatments, though the reduction was less than that observed for Whole Health users at three months (22% vs. 42%, respectively), and at 18 months was only 1% lower compared with Veterans who received conventional care. This suggests that the integration of CIH therapies with Whole Health care leads to greater and more durable reductions in chronic pain symptoms.
- Implementation and evaluation of the Vet-to-Vet Program are being led by HSR’s Seattle-Denver COIN in collaboration with national partners such as OPCC&CT, the CDC, and VA’s Prescription Drug Monitoring Program. The Vet-to-Vet Program provides online support for Veterans living with chronic pain, featuring group meetings to build community and improve the well-being of attendees, with facilitation provided by trained Veterans who have experienced chronic pain. Funded by the Office of Rural Health since FY2022, the Vet-to-Vet Program is active at 10 VA sites with more than 2,700 encounters to date and an additional 10+ sites starting in FY2025.
- An HSR-funded clinical trial (July 2020–June 2025)[5] is evaluating the effectiveness and implementation of Patient Priorities Care (PPC) for older Primary Care Veterans with multiple chronic conditions. PPC focuses on aligning care with patients’ health goals within the context of their health conditions and the healthcare they are willing and able to receive. The study’s early findings suggest that PPC might help improve some important health outcomes for older adults (e.g., reducing treatment burden), but further research is needed to determine the potential effects of priorities-aligned care. To date, 27 VA facilities have implemented the PPC approach, while nationally available PPC training modules have further supported the spread of PPC to nearly every VA facility. The OPCC&CT recognizes PPC as a Whole Health Clinical Care model for older adults, helping to establish PPC as a standard of care in the practice of geriatrics.
Partners
Geriatrics and Extended Care Central Office
Office of Patient-Centered Care and Cultural Transformation
Office of Mental Health
Office of Rural Health
Office of Suicide Prevention
Office of Women’s Health
National Center for PTSD
Recent Related Publications
[1] Spreading Use of a Well-Being Measure to Enhance Veterans’ Whole Health
[2] Transforming the Veterans Affairs to a Whole Health System of Care
[3] Whole Health Is Positively Associated with Multiple Measures of Care Quality
[4] VA’s National Implementation of Whole Health and Impact on Patient Experiences
[5] Patient Priorities-Aligned Care for Older Adults with Multiple Conditions
