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2023 HSR&D/QUERI National Conference Abstract

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1003 — The VA Whole Health National Demonstration Project – Impact on Experiences of Care, Patient Engagement and Well-being

Lead/Presenter: Barbara Bokhour,  COIN - Bedford/Boston
All Authors: Bokhour BG (Center for Healthcare Organization and Implementation Research, Department of Population and Quantitative Health Sciences, University of Massachusetts), DeFaccio R (Center of Innovation for Veteran-Centered and Value-Driven Care) Gaj LJ (Center for Healthcare Organization and Implementation Research) Barker A (Center for Healthcare Organization and Implementation Research) Deeney C (Center for Healthcare Organization and Implementation Research) Douglas J (Center of Innovation for Veteran-Centered and Value-Driven Care) Gelman H (Center of Innovation for Veteran-Centered and Value-Driven Care) Coggeshall S (Center of Innovation for Veteran-Centered and Value-Driven Care) Taylor SL (Center for the Study of Healthcare Innovation, Implementation and Policy, Center for the Study of Healthcare Innovation, Implementation and Policy, Department of Health Policy and Management, UCLA School of Public Health) Thomas E (Center of Innovation for Veteran-Centered and Value-Driven Care) Zeliadt S (Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Health Systems and Population Health, School of Public Health, University of Washington)

Objectives:
The VA’s Office of Patient Centered Care and Cultural Transformation (OPCCandCT) has been developing a patient-centered Whole Health System of care (WHS), comprised of the Whole Health (WH) pathway, clinical care guided by a WH approach, and well-being programs (including complementary integrative health). This patient-centered system is designed to assess what matters most to the Veteran and provide care aligned with Veteran’s goals, preferences, and priorities. We conducted an evaluation in partnership with OPCCandCT to assess the impact of receiving WH care on patient-reported outcomes, in part to respond to a Congressional evaluation mandate in the Comprehensive Addiction and Recovery Act.

Methods:
We conducted a longitudinal survey with a stratified random sample of Veterans with chronic pain using primary care, mental health, or well-being services at 18 flagship medical centers piloting the WHS. We assessed use of WH services using electronic medical record data and patient self-report of services on the survey. We examined differences in patient-reported outcomes at 6-months between Veterans receiving WH and those receiving conventional care (CC). The primary outcome was change in pain measured with the 3-item PEG, adjusted using inverse probability of treatment weights. Twenty-two secondary outcomes, guided by a WH logic model, were examined including: 1) Experiences of care - Satisfaction, Help with Goals, and Consultation and Relational Empathy (CARE); 2) Patient engagement - Altarum Consumer Engagement (ACE); and 3) Well-being (PROMIS10).

Results:
19,790 Veterans were invited to participate with a 49.0% baseline and 34.6% overall response rate. Among responders, 1,053 received Whole Health (WH) and 3,150 received conventional care (CC). Baseline pain PEG scores were 6.2 for the WH group and 6.4 for the CC group (p = 0.027), improving by -0.15 (p = 0.007) and -0.14 (p < 0.001), respectively. In adjusted analyses WH was not associated with greater improvement in PEG scores at 6 months compared to the CC group (-1.0%; 95%CI: -2.9% to 1.2%) In adjusted analyses of secondary outcomes, WH was associated with greater improvements in likelihood to recommend VA (2.0%; 95%CI: 0.9% to 3.3%), discussions of goals (11.8%; 95%CI: 8.2% to 15.5%); receipt of patient-centered communication (CARE)(2.5%; 95%CI: 0.4% to 4.6%), engagement in health behaviors (ACE)(2.2%; 95%CI: 0.3% to 3.9%) and engagement in healthcare decisions (ACE)(1.5%; 95%CI: 0.1% to 3.0%). Most scores improved for other measures, including PROMIS10, but these improvements were not significantly different between the WH and CC groups.

Implications:
Patients who received WH care as part of this national implementation project reported improvements in several patient-reported outcomes. Although pain did not improve more with receipt of WH care in the short term, the greater improvements in experiences of and engagement in care at 6-months may lead to longer term improvements in pain and well-being.

Impacts:
These findings support the ongoing effort in VA to expand the implementation of WH throughout the nation. Prior research has shown that patients who have better experiences of care and are more engaged have better long-term outcomes. Improvements in well-being and longer-term medical outcomes may take time, yet these findings indicate that implementing such system change holds great promise.