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2019 HSR&D/QUERI National Conference Abstract

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1092 — Characterizing patient-reported quality of life and care satisfaction in a national VA quality improvement program

Lead/Presenter: Shari Rogal,  COIN - Pittsburgh/Philadelphia
All Authors: Rogal SS (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System), Yakovchenko V (Center for Healthcare Organization and Implementation Research, BridgeQUERI, Bedford), Gonzalez R (VA Long Beach Healthcare System) Park A (Office of Healthcare Transformation) Lamorte C (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Gibson SP (Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System) Chartier M (HIV, Hepatitis and Related Conditions Programs, Office of Specialty Care Services) Ross DB (HIV, Hepatitis and Related Conditions Programs, Office of Specialty Care Services) Comstock E (Baltimore VA Medical Center) Bajaj JS (McGuire VA Medical Center, Virginia Commonwealth University) Morgan TR (VA Long Beach Healthcare System)

Objectives:
The Veterans Health Administration has prioritized addressing patient experience and access to care. In 2015, the HIV, Hepatitis, and Related Conditions Program Office developed the Hepatic Innovation Team (HIT) learning collaborative to support teams of providers in improving access to high quality care for liver disease. Our evaluation team aimed to characterize patient experience within this national quality improvement effort.

Methods:
We identified Veterans with cirrhosis using a national dashboard. We mailed surveys to 8 of these patients from each VA center, oversampling patients with decompensated (advanced) cirrhosis. The survey asked about satisfaction with VA care, symptoms, medical problems, and quality of life (QOL) using the Veterans Rand 12-Item Health Survey (VR-12). We used descriptive statistics to summarize responses, linear regression models to compare VR-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores by participants' baseline characteristics, and ANOVA to assess the association between QOL and satisfaction with care.

Results:
We received 265 completed surveys (24% response rate). Most respondents were male (96%) and 49% had decompensated liver disease. Of 250 patients who completed the satisfaction question, 190 (76%) reported being satisfied with care and 60 (24%) reported being dissatisfied with their care. We found an average PCS = 30±11 and MCS = 41±13 overall, compared to standardized population means of 50±10. PCS was significantly lower among patients with decompensated vs. compensated cirrhosis (28 vs. 31, p = 0.03), while the MCS did not significantly differ between groups. The factors significantly associated with PCS were hepatic decompensation (? = -2.76,p = 0.03), comorbidities (? = -2.9 to -7.2,p < 0.03) and age (? = 0.2,p = 0.03). Lower MCS was associated with comorbidities (? = -3.1 to -6.9,p < 0.05) and age (? = 0.2,p < 0.01). Higher QOL was significantly associated with higher satisfaction with care (p < 0.01).

Implications:
Most Veterans with cirrhosis were satisfied with VA care for their liver disease. Both the PCS and MCS components of QOL are reduced for Veterans with cirrhosis, and satisfaction with care is associated with QOL in this population.

Impacts:
Our novel program evaluation aims to assess both site-level process metrics as well as patient-level QOL and satisfaction with care. Our future quality improvement efforts will focus on tracking and improving QOL over time.