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2019 HSR&D/QUERI National Conference Abstract

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1034 — Empowering Patients in Chronic Care: Randomized Clinical Trial of a Whole Health Intervention

Lead/Presenter: LeChauncy Woodard,  COIN - Houston
All Authors: Woodard LD (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas), Hundt N (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas), Amspoker AB (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas) Kamdar NP (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas) Odom EA (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas) Naik AD (Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VAMC, Houston, Texas)

Objectives:
VA has championed Whole Health as an innovative approach to healthcare that empowers and enables Veterans to take charge of their health and well-being. This approach is essential for improving health outcomes in Veterans with diabetes. Empowering Patients in Chronic Care (EPIC) is an evidence-based, 6-week intervention with individual and group training on Whole Health, collaborative goal-setting, communication, and action planning. The objective of the current study is to evaluate the effectiveness of EPIC to improve glycemic control and reduce diabetes-related distress in routine VA primary care.

Methods:
The current study is a multisite, randomized controlled trial of an intervention delivered at five VA primary care clinics across 2 VISNs. Interprofessional, PACT providers were recruited and trained to deliver EPIC as part of routine care. Using multilevel regression models, we assessed differences in hemoglobin A1c (HbA1c) and diabetes distress scores (DDS) between EPIC and enhanced usual care (EUC) post-intervention. For each HbA1c and DDS, the value at post-intervention was the dependent variable, treatment group was the independent variable, and the respective baseline value of the outcome served as a covariate. Analyses were intention-to-treat (ITT) with multiple imputation procedures to address missing data.

Results:
We randomized 280 veterans to EPIC and EUC. At baseline, the groups were similar with the exception that EUC veterans were more likely to have prior diabetes education (p = 0.004). Veterans were predominantly older men with poorly controlled diabetes (mean baseline HbA1c = 9.1%) and moderate levels of diabetes distress (mean baseline DDS = 2.43). Patients in EPIC were more likely than those in EUC to improve HbA1c [F(1, 252) = 9.12, p = 0.003, (95% CIs = 0.12, 0.59)] and DDS levels [F(1, 245) = 9.06, p = 0.003, (95% CIs = 0.13, 0.60)].

Implications:
We demonstrated that a Whole Health approach to diabetes care using the EPIC intervention is effective at reducing HbA1c and DDS levels. These results demonstrate that interprofessional PACTs can successfully conduct Whole Health interventions as part of routine primary care.

Impacts:
Whole Health interventions, such as EPIC, can empower Veterans to effectively manage their diabetes using a holistic, patient-centered approach to care.