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2019 HSR&D/QUERI National Conference Abstract

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1032 — Health goal-setting and achievement among Veterans with high technology adoption

Lead/Presenter: Rachael Martinez,  COIN - Hines
All Authors: Martinez RN (Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL), Smith BM (Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL; Center for Healthcare Studies, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL), Etingen B (Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital) Shimada S (Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA; Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA) Cutrona S (Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA) Richardson L (Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA) Hogan TP (Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA)

Objectives:
Patient-led goal-setting has proven effective for improving health behavior change and outcomes. We examined the relationships between Veteran patient characteristics, patient-provider discussions, and mobile health app use on health goal-setting and achievement.

Methods:
The eHealth Partnered Evaluation Initiative and Office of Connected Care launched a novel effort to develop a cohort of Veterans to provide feedback on VA connected-care technologies and improve their integration into practice, referred to as the "Veterans Engagement with Technology Collaborative" (VET-C) cohort. The VET-C cohort consists of over 2,700 Veterans who participated in a telephone survey administered in 2017. Of these, 2,552 provided complete survey data on goal-setting behaviors. VA administrative data was linked to survey data for additional demographics.

Results:
Among our cohort, 74.8% of Veterans indicated having set health goals in the prior 6 months, and most described the type of goal that they had set. Approximately 42% indicated achieving that goal. Women Veterans had lower odds of setting goals compared to men (OR: 0.72; CI95: 0.53-0.97), as did individuals with higher hierarchical condition category risk scores (i.e., worse health) (OR: 0.20; CI95: 0.04 - 0.98) compared to those in better health. Individuals with advanced education—some college, and post-college degrees—demonstrated higher odds of setting goals (OR: 1.34; CI95: 1.01-1.79, and OR: 1.71; CI95: 1.28-2.28, respectively), compared to those with no college education. The strongest positive association emerged between goal discussion with VA providers and goal setting, with those reporting having discussed their goals with their providers being far more likely to set goals (OR: 3.60; CI95: 2.97-4.35). Veterans who reported setting goals related to weight management, smoking cessation, and pain management were less likely to achieve them. Patient use of mobile health apps was not statistically associated with goal achievement.

Implications:
Patient-provider conversations as well as patient characteristics, including gender, education, and health, appear integral to patient-led goal-setting.

Impacts:
Efforts to further integrate patient-led goal-setting into VA clinical practice should leverage the influence of patient-provider discussions. Provider endorsement of mobile health apps may support technology use for goal achievement. Providers must be sensitive to how patient characteristics may shape goal-setting behaviors.