2015 National Conference

3183 — Examining the Implementation of VA's Personal Health Planning Tool for Veteran-Centered Care

Fix GM, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; Boston University; Solomon JL, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; Bolton RE, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; VanDeusen Lukas C, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; Boston University; Bokhour BG, Center for Evaluating Patient-Centered Care in VA; Center for Healthcare Organization and Implementation Research; Boston University;

Objectives:
The Blueprint for Excellence identifies personal health planning as a strategy to provide "health care that is personalized, proactive, and patient-driven." VA's Office of Patient-Centered Care is leading these efforts through their innovative health planning tool, the Personal Health Inventory (PHI). The PHI consists of a series of questions designed to shift conversations away from traditional, disease-focused discussions to those focused on patients' lives and goals. Implementation of this tool is likely to be complex given the cultural shift needed to refocus a clinical encounter. The PHI is beginning to be utilized throughout the VA. We sought to understand how it is being implemented, how it is changing the conversation and, importantly, how patients experience these changes.

Methods:
We conducted a formative evaluation at two pilot, primary care clinics, over 2 years. In Year 1, we conducted semi-structured providers interviews (N = 11) to understand how PHI was being implemented. In Year 2, we revisited each site for day-long observations of interactions (N = 25) and informal provider (N = 20) and patients (N = 8) interviews, to examine patient experiences of the PHI. Observations were recorded in a fieldnote template. Data were analyzed using an iterative process combining a priori and emergent analysis procedures.

Results:
From the provider interviews, we learned how sites had addressed challenges integrating PHI into their clinical context. At Site 1, a PHI reminder was created in the electronic medical record, with individualized templates for different PACT team members. In contrast, Site 2 limited PHI implementation to the initial questions, which focus on what really matters most to patients. At Site 1, we observed LPNs rotely reading the PHI template, alongside other clinical reminders. There was minimal framing. Goal setting was poorly matched with patients' responses. At Site 2, despite not completing the entire PHI, providers focused on patient priorities and worked towards patient goal setting.

Implications:
Integration of the PHI requires more than templates and attention to clinical workflow. A focus on the spirit of patient-focused goal setting is critical to the success of PHP implementation.

Impacts:
As PHI implementation expands, provider trainings focused on patient-centered communication, are key.