Lead/Presenter: Hill Wolfe,
COIN - Bedford/Boston
All Authors: Wolfe HL (Center for Evaluating Patient-Centered Care, Bedford, MA; Boston University School of Public Health, Boston, MA), Bolton R (Center for Evaluating Patient-Centered Care, Center for Healthcare Organization and Implementation Research, Bedford, MA; Brandeis University Heller School for Social Policy and Management, Waltham, MA), Fix GM (Center for Evaluating Patient-Centered Care, Center for Healthcare Organization and Implementation Research, Bedford, MA; Boston University School of Public Health, Boston, MA) Bokhour BG (Center for Evaluating Patient-Centered Care, Center for Healthcare Organization and Implementation Research, Bedford, MA; Boston University School of Public Health, Boston, MA)
The VA is transforming the delivery of healthcare from "What's the matter with you?" to "What matters to you?" consistent with its mandate to implement a Whole Health (WH) approach to care. VA's Office of Patient-Centered Care and Cultural Transformation (OPCCandCT) developed Whole Health: Change the Conversationâ€” a comprehensive and intensive three-day skills-based training to promote personalized, proactive, patient-driven care. We sought to evaluate how this training impacted physicians' engagement in WH communication with Veterans.
We developed a communication assessment tool based on 8 VA primary care physicians' audio-recordings of clinical encounters with Veterans before and after participating in training (N = 65 recordings). We used an iterative process to develop and refine a structured tool to score the frequency and quality (range: 0-4) of physician's incorporation of key course components including asking Veterans "What really matters?" in their lives and integrating components of proactive health and well-being. 21 audio recordings were jointly coded using constant comparison methods to reach consensus among 5 team members. Remaining recordings were coded with periodic consensus checks. After frequency and quality scores were logged, unpaired sample t-tests were used to assess change pre-and post-training.
We found variation in how well physicians incorporated components of WH following participation in the 3-day training. Occurrences of asking "What really matters?" tripled between pre- (N = 5/30) and post-training (N = 15/35). Average quality scores did not significantly change. Discussions of WH components were initiated by physicians 2.7% more after training (N = 150/232) than before (N = 169/273). Quality scores for these discussions significantly increased post-training (pre: x? = 1.68, s = 0.81; post: x? = 1.84, s = 1.08; t = -1.89, p = 0.029).
We developed a reliable method for evaluating Whole Health: Change the Conversation. After participating in the OPCCandCT training, physicians improved the quality of discussing WH concepts with Veterans. Training could be refined to further increase the frequency of communicating WH concepts and quality of discussions surrounding what really matters to Veterans. Additionally, physicians may benefit from ongoing clinical coaching.
As VA transforms to a WH system of care, identifying components of training which are likely to change physician behaviorâ€” and mechanisms to evaluate these changes such as the tool we have developed â€” will be critical.