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2019 HSR&D/QUERI National Conference Abstract

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1036 — Participating in Complementary and Integrative Health Approaches Improves Veterans' Patient Reported Outcomes over Time

Lead/Presenter: A. Rani Elwy,  COIN - Bedford/Boston
All Authors: Elwy AR (Center for Healthcare Organization and Implementation Research, Bedford; Complementary and Integrative Health Evaluation Center, QUERI PEI), Taylor ST (Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles; Complementary and Integrative Health Evaluation Center, QUERI PEI), Zhao S (Center for Healthcare Organization and Implementation Research, Bedford) McGowan MG (Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles; Complementary and Integrative Health Evaluation Center, QUERI PEI) Plumb DN (Center for Healthcare Organization and Implementation Research, Bedford) Westfield W (East Orange VA Medical Center, VA New Jersey Healthcare System) Gaj L (Center for Healthcare Organization and Implementation Research, Bedford) Yan GW (VA Office of Patient Centered Care and Cultural Transformation, Central Office) Bokhour BG (Center for Healthcare Organization and Implementation Research, Bedford; Evaluating VA Patient Centered Care, QUERI PEI)

Objectives:
VA is dedicated to providing a Whole Health approach to care, including offering complementary and integrative health (CIH) services. As a learning healthcare system (LHS), VA strives to continuously monitor health outcomes from care approaches and make this information available for improved decision-making by clinicians, patients and families. This prospective, longitudinal study of Veterans participating in any type of CIH approach (e.g., yoga) at two VA medical centers and its subsequent impact on Veterans' reported outcomes adds to VA's LHS practices.

Methods:
Veterans involved in any CIH approach were invited to participate in a patient reported outcomes repeated survey at five time points: baseline, 2, 4, 6, 12 months. Surveys were completed in person, by telephone or mail, as needed. Mixed hierarchical models with repeated variables were used to test the hypothesis that participating in any CIH approach would improve Veterans' overall physical/mental health and pain intensity (PROMIS 29), perceived stress (PSS-4) and engagement in their care (PAM-13), controlling for age, male sex and site.

Results:
We received 401 surveys from 119 Veterans (72% male, age range 29-85 years) across the 5 time points. Meditation and visits to an integrative medicine (IM) nurse practitioner resulted in significant reductions in pain intensity over the 6-month (meditation, p < 0.05) and 12-month (IM nurse, p < 0.01) time points, compared to baseline scores. Tai chi also significantly improved overall physical and mental health over 6 months (p < 0.005). There was a trend for yoga to reduce perceived stress over the 12-month period, but this did not reach statistical significance. No CIH approach improved Veterans' engagement in their care.

Implications:
Knowing that meditation, IM nurse visits, tai chi and yoga reduce pain intensity, improve overall physical and mental health and have the potential for reducing perceived stress should allow for clinicians, Veterans and family members to use this knowledge to improve patient-clinician communication about engaging in CIH treatments approaches.

Impacts:
Our study contributes to LHS practices and the CARA legislation on CIH education and research by capturing the best available evidence from VA patients participating in CIH and uses their perspectives (e.g., patient reported outcomes) as part of continuous improvement and learning.