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2015 HSR&D/QUERI National Conference Abstract

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3168 — Understanding Personal Health Planning Across VA

Bolton RE, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; Bokhour BG, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; Boston University; Luger TM, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; eHealth QUERI; Hogan TP, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; eHealth QUERI; Ruben M, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; Fix GM, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; Boston University;

Objectives:
Personal Health Planning (PHP) is a cornerstone of VA's Blueprint for Excellence as a mechanism to transform health care from provider-focused to Veteran-centric. PHP involves Veterans and providers collaboratively identifying health goals to focus care around Veterans' life priorities, and is being widely implemented throughout VA. However, VAMCs have been given latitude to operationalize PHP and develop their own corresponding procedures. Subsequently, little is known about how VAMCs are conducting PHP in the field. This qualitative study sought to describe VAMCs PHP procedures and identify key considerations for PHP implementation.

Methods:
Semi-structured interviews were conducted with individuals leading PHP implementation at 12 VAMCs identified as early adopters. Participants were asked to describe their PHP procedures. Using a content analysis, a multidisciplinary team coded interview transcripts using a priori categories derived from study goals, and identified emergent themes grounded in the data. Site summaries were created within categories and reviewed using constant comparison. The team met weekly to discuss analysis, resolve disagreements, and synthesize results.

Results:
Sites reported differences in procedures used to develop patients' PHPs, including variation in target populations, clinical settings, individuals responsible for PHP delivery (staff/providers/peers), modes of delivery (group/individual and mail/in-person formats), and utilization of multiple assessment tools. Despite these disparate procedures, we found five universal elements across the 12 sites. These core components of PHP included: (1) Selecting a target population; (2) Starting the conversation by introducing PHP; (3) Deepening the conversation by fully assessing patient priorities; (4) Concretizing the conversation by collaboratively setting health goals and establishing action plans; and (5) Acting on the conversation by connecting patients with VA or community resources to support their goals.

Implications:
Sites adapted PHP in myriad ways to meet their local contexts and resources, yet we identified five core components across all sites that emerged as key features of the process. As PHP is widely implemented across VA, developing local procedures that attend to these features will be crucial.

Impacts:
In response to the Blueprint's charge to implement PHP, best practices can now be assessed within these five universal components, and a toolkit can subsequently be developed to optimize PHP implementation.