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2015 HSR&D/QUERI National Conference Abstract

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1105 — Does Integrative Health Coaching Impact Health Outcomes and Healthcare Utilization among Veterans Who are Homeless or at Risk for Homelessness?

Etingen B, Center of Innovation for Complex Chronic Healthcare (CINCCH); Miskevics S, Center of Innovation for Complex Chronic Healthcare (CINCCH); Hill JN, Center of Innovation for Complex Chronic Healthcare (CINCCH); Jordan N, Center of Innovation for Complex Chronic Healthcare (CINCCH); Northwestern University Chicago; Goolsby E, Fayetteville VA Medical Center; Diaz C, Fayetteville VA Medical Center; LaVela SL, Center of Innovation for Complex Chronic Healthcare (CINCCH); Northwestern University Chicago;

Objectives:
To examine health outcomes and healthcare utilization before and after implementation of an integrative health coaching (IHC) initiative in a cohort of Veterans who are homeless/at-risk.

Methods:
An observational-cohort study design was used to examine patient outcomes at one large VA health care facility and associated clinics. VA administrative databases provided demographics, health conditions, health outcomes, and health care utilization for Veterans who are homeless/at-risk and received care during both pre-IHC: 01/01/09-01/01/11and post-IHC: 09/01/11-04/30/14. The time period during which providers were undergoing IHC training was excluded.

Results:
For homeless/at-risk Veterans who received care at the facility before and after the IHC initiative (n = 181), during the post-IHC (vs. pre-IHC) time period, the average number of overall outpatient visits (61.5 vs. 35.1, p < .0001), mental health specialty care visits (37.7 vs. 20.4, p < .0001), and encounters with VA-provided programs for homeless/at-risk (23.6 vs. 7.5, p < .0001) increased. There were a greater average number of visits associated with heart disease (0.3 vs. 0.1, p = 0.02) and post-traumatic stress disorder (PTSD) (3.1 vs. 1.5, p = 0.05) post-HC (vs. pre-HC). The average number of no-shows post-IHC increased from pre-IHC (7.5 vs. 6.0, p = 0.05). The average number of prescriptions filled overall was greater post-IHC (vs. pre-IHC) (36.3 vs. 26.7, p = 0.01), but there were no differences in psychotropic prescriptions filled.

Implications:
Outpatient visits, mental health specialty care visits (including visits related to PTSD), and prescription medication use increased after IHC was implemented; we believe this indicates improved use of recommended, necessary healthcare. Our findings suggest that use of IHC in this cohort may facilitate Veteran engagement in, and connection to, their health care. The number of no-shows also increased post-IHC, however, this may be due to increased potential encounters. Increases in medication use of general, but not psychotropic prescriptions, suggest that with increased utilization, chronic conditions may be getting addressed, and that more alternative treatment modalities for mental health concerns, e.g., PTSD may have been offered as part of IHC.

Impacts:
IHC may be an effective approach to promote active participation and engagement in health care among homeless Veterans, including those with mental health diagnoses, conditions in which treatment and follow-up are often challenging.