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2015 HSR&D/QUERI National Conference Abstract

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3161 — Integration of MyHealtheVet (MHV) into the Management of Heart Failure (HF) patients in the Patient-Aligned Care Teams (PACTs)

Dang S, Miami VAHS/GRECC; Gomez-Orozco CA, Miami VAHS/GRECC; Sorial AL, Miami VAHS/GRECC; Ruiz DI, Miami VAHS/GRECC; Siddharthan K, Tampa VAHS; Gomez-Marin OW, Miami VAHS; Rodriguez R, Miami VAHS;

Objectives:
The purpose of this project was to assess the feasibility of using MyHealtheVet (MHV), VA's comprehensive personal health record, as an educational case-management platform. This project at Miami and Tampa VAs implemented MHV for Veterans with heart failure (HF). Every week a new one page HF educational document was sent to each participant via secure-messaging, along with a HF symptom checklist. Weekly participant responses were resolved or assigned to the patient-aligned care team (PACT) or CHF clinic.

Methods:
The project enrolled and authenticated 118 HF patients. Their average age was 65.1±9.6 (SD) years, range 41-91 years, 95% Confidence Interval (CI) = [63.4-66.9]. A total of 103 (87.3%) were non-Hispanic, and 15 (12.7%) were Hispanic; included were 90 (76.3%) Whites, 20 (16.9%) Blacks, and 8 (6.8%) other race, and median yearly income was $20,292. Independent samples t-tests, Chi-square tests, and paired samples t-tests were used, as appropriate.

Results:
Initial monitoring lasted 26 weeks. Among the 118 participants, 55 (46.6%) used MHV between 7-26 weeks. Response rate averaged 46.6±29.6%, and ranged from 5-100%. Out of the 55 participants who ever responded, 17 responded less than 25% of the weeks, 12 responded 25-50% of the weeks, 16 responded 50-75% of the weeks, and 10 responded > 75% of the weeks. A total of 26 participants responded at least 50% of the weeks they were enrolled. Among the 55 participants who ever responded, the number of response weeks ranged from 1 to 26 with a median of 8 and a mean ± SD of 9.4±7. A statistically significant improvement in patient knowledge was measured (p = 0.011). However, the Minnesota Living with HF and Chronic Disease Self-Efficacy showed no significant change. Moreover, MHV use in renewing medications, checking lab results, reading health information, and using secure-messaging had statistically significant increases.

Implications:
Such interventions with weekly secure-messages increase knowledge and use of MHV. Computer/internet access and usability issues are anticipated problems. Usability and technical issues faced by participants may likely be overcome by additional training for both patients and providers.

Impacts:
MHV-based interventions maybe a feasible modality to monitor and educate patients, and a low cost case-management platform for chronic conditions.