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2015 HSR&D/QUERI National Conference Abstract

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1002 — Impact of Veteran-Mediated Health Information Sharing on Quality of Care for Dual-Use Veterans

Turvey CL, Comprehensive Acces & Delivery Research & Evaluation CADRE Iowa City; Klein DM, Comprehensive Access & Delivery Research & Evaluation CADRE Iowa City, IA; Witry M, University of Iowa College of Pharmacy; Klutts S, Iowa City VA Health Care System Iowa CIty; Pham K, Comprehensive Access and Delivery Research and Evaluation- CADRE Iowa City; Suiter N, Comprehensive Access & Delivery Research & Evaluation CADRE Iowa City; Franciscus C, Comprehensive Access and Delivery Research & Evaluation - CADRE Iowa City; Nazi KM, Veterans and Consumers Health Informatics Office, Office of Informatics and Analytics, VHA;

Objectives:
An estimated 40 to 70% of VA enrollees also receive medical care outside the VA, which is called dual use. Dual use will increase as a result of the Veteran's Choice Act. Prior studies have demonstrated poorer health outcomes in dual use Veterans raising concerns about the coordination of care. The VA is currently implementing Veteran-mediated health information exchange through the Blue Button feature of My HealtheVet. The Blue Button allows Veterans to generate a VA Health Summary of information taken directly from CPRS.

Methods:
This was a pilot two-arm randomized controlled trial where 52 Veterans were randomized to either 1) receive training on how to generate a VA Health Summary to share with their non-VA provider OR 2) Attention Control training on evaluating the quality of health information on the Internet. Veterans were then followed to their next non-VA medical visit where they and their providers were asked to complete a brief one-page assessment. Medical records for the non-VA visits were obtained.

Results:
Ninety-percent of Veterans in the Health Summary training arm brought it to their next non-VA provider visit as compared with 17% in the Attention Control training (P < 0.001). Ninety-percent of the non-VA providers indicated that having the VA Health Summary improved their ability to manage Veterans' medications. A third of these providers indicated that they did not order laboratory tests because of the information available on the VA Health Summary. Medical record review confirmed that there were no duplicate laboratory draws in the Health Summary arm, while 28% of the Attention Control group did have a duplicate laboratory (p < 0.01). There were no group differences in medication concordance. Sixty-seven percent of Veterans endorsed that the VA Health Summary helped them to become more involved in their healthcare and 81% endorsed that they will regularly share their Health Summary with non-VA providers.

Implications:
Training Veterans to use My HealtheVet for health information sharing will lead to increased satisfaction and reduction in duplicate laboratories. Its impact on medication reconciliation is not clear.

Impacts:
The My HealtheVet Blue Button can empower dual use Veterans to improve care coordination between VA and non-VA providers.