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2023 HSR&D/QUERI National Conference Abstract

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4027 — Veteran Use of and Perceptions About Virtually Delivered Whole Health Services

Lead/Presenter: Bella Etingen,  COIN - Hines
All Authors: Etingen B (Center of Innovation for Complex Chronic Healthcare (CINCCH)), Wirth M (Center of Innovation for Complex Chronic Healthcare (CINCCH)) Kloehn A (Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care) Escudero G (Center of Innovation for Complex Chronic Healthcare (CINCCH)) Kale IO (Center of Innovation for Complex Chronic Healthcare (CINCCH)) Deeney C (Center for Healthcare Organization and Implementation Research (CHOIR)) Defaccio RJ (Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care) Chen CL (Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care) Taylor SL (Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP)) Stockdale SE (Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP)) Lott B (Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP)) Hogan TP (Center for Healthcare Organization and Implementation Research (CHOIR)) Bokhour BG (Center for Healthcare Organization and Implementation Research (CHOIR))

Objectives:
The Veterans Health Administration’s (VHA) transformation into a ‘Whole Health system of care’ (WHS) has encompassed a shift in organizational culture, wherein care delivery is focused on Veteran goals and preferences rather than diagnoses alone. The WHS is comprised of Whole Health (WH) services (e.g., WH coaching, well-being classes) and complementary and integrative health (CIH) services. In the wake of the COVID-19 pandemic, VHA rapidly shifted service delivery to a virtual format. For most WH and CIH services, the virtual format (i.e., ‘tele-Whole Health’ (tele-WH)) was a novel delivery platform. Our goal was to assess Veteran use of and perceptions about tele-WH services.

Methods:
We used VHA administrative data to identify 2,000 Veterans from 10 nationally dispersed VHA facilities who had used tele-WH services and had an email address on file, and invited them to complete an online survey. Our survey was developed iteratively and refined based on Veteran feedback gathered through cognitive interviews, and contained internally developed questions and validated patient-reported outcome measures (e.g., Perceived Stress Scale). The survey collected data on Veteran: (1) use of and interest in, (2) experiences and satisfaction with, (3) perceived outcomes of, and (4) sources of information about tele-WH services. Survey data were characterized using descriptive statistics.

Results:
We received responses from n = 463 Veterans (24% response rate). Among respondents, Veterans most frequently endorsed using virtually-delivered WH Coaching (33%), health promotion/disease prevention groups (26%), and yoga (21%), and most frequently reported interest in trying massage (29%), yoga (28%), chiropractic care (21%), acupressure (20%), and meditation (19%). Most reported that they liked tele-WH services (74%) and would recommend them to other Veterans (78%). Veterans most frequently reported learning about tele-WH services from VHA websites (24%), conversations with their VHA care team members (23%), and emails from VHA (21%). The most frequently endorsed reasons for using tele-WH services were that: it was more convenient than participating in-person (63%), the technology needed to participate was easy to use (50%), and the virtual offering was the only option available at the time (46%). Respondents most frequently endorsed that participating in tele-WH helped them ‘a lot’ to: be better engaged in their health care (52%), manage their health better (44%), and achieve their personal health goals (39%).

Implications:
Veterans who used tele-WH services were largely satisfied, reported that use of tele-WH services helped them be more engaged with their health and health care, and endorsed interest in trying a variety of tele-WH services. Veterans most commonly learned about tele-WH services through VHA sources, including websites, emails, and word-of-mouth from care team members.

Impacts:
Although the shift to tele-WH services was in response to the COVID-19 pandemic, our findings indicate that Veterans have high interest in continued use of these virtual WH offerings. This suggests that VHA should expand availability of tele-WH. Our data further highlights sources of information VHA can leverage to facilitate Veteran awareness of and participation in tele-WH services.