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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


1064 — My HealtheVet: A Novel Approach for Optimizing Quality of Care Among Veterans

Author List:
Arar N (VA)
Agarwal M (VA)
Valpp B (VA)
Kinsinger L (VA)
Ferguson L (VA)
Wonch D (VA)
Corpuz L (VA)
Pugh J (VA)
Price G (VA)
Powell B (VA)

Objectives:
My HealtheVet (MHV) is the VHA Health Portal created to allow veterans, their family, and VA employees to access health information, tools and services through the Internet. One important aspect of MHV is Wellness Reminders (WRs), which aim is to enhance patients’ activation in order to optimize the use of health care technology and thus improve quality of care. WR(s) utilize the National Clinical Practice Guidelines to promote state-of-the art for disease prevention and management among veterans. Our aim is to assess (1) patients’ opinions regarding the importance and the utilization of MHV and WR(s) and (2) the structure, readability, and content of 8 different WR(s).

Methods:
Semi-structured interviews were conducted with a convenience sample of 30 patients with diabetes and other chronic illnesses attending a VA primary care outpatient clinic in San Antonio, TX. The interviews examined (1) patients’ views of MHV and WR(s), its value and future utilization, and (2) content validity of the 8 WR(s). All interviews were audiotaped, transcribed, and content analyzed using software Atlas Ti. Additionally, we used Microsoft Office Word (2003) to assess the structure (e.g., typographical errors and style), readability ease, and the grade level of each paragraph of all WR(s). These WR(s) included information on: colorectal cancer, Diabetic eye exam, Foot exam, Pneumonia and Influenza vaccine, Mammogram, Cervical cancer screens and HbA1c. WR(s) included information on: colorectal cancer, Diabetic eye exam, Foot exam, Pneumonia and Influenza vaccine, Mammogram, Cervical cancer screens and HbA1c.

Results:
All patients indicated that MHV and WR(s) are major advancement in VA healthcare system. Content analysis identified three different categories regarding the utilization of MHV and WR(s): (1) 20% of the patients who were familiar with computers and the Internet, indicated that they will use MHV and WR(s). (2) 25% of the patients didn’t have or know how to use a computer, indicated that they do not see any value in MHV for them. (3) 55% didn’t have computer but desired to learn how to use it, indicated that MHV and WR(s) would be very helpful. One patient in this group said: “I’m just now learning how to use a computer and don’t have Internet access. Maybe eventually I will have Internet and know how to use it, and then it would be nice to look this up. I do think the idea of MHV and the reminders will be helpful”. WR(s) recorded an average of 70% (range: 59-78) and 5th grade (range: 4.1-7.9) level for both the Flesch reading ease and Flesch-Kincaid Grade Level respectively. However, readability measures are scores based on the surface characteristics of the text such as the number of words in the sentences and the number of letters or syllables per word thus didn’t capture comprehension and content. Therefore, all reminders were reviewed with the enrolled patients to assess cultural, linguistic and content equivalence. Patients agreed that the content of the reminders was very clear, sensitive and understandable.

Implications:
MHV and WR(s) are novel approaches to improve the quality of care for Veterans. WR(s) showed high reading and content validity. However, the utilization of MHV and WR(s) will depend to a large degree on veterans’ familiarity and accessibility to computers and Internet. Future studies should focus on understanding factors that hinder or facilitate veterans’ utilization of MHV and its components.

Impacts:
Advancement in VA information technology such as the creation of MHV holds enormous promise for optimizing quality of care among veterans. Challenges may arise for the utilization MHV based on differences in patients’ experiences in using computers and Internet.


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