4045 — Coming Back for More: Conditions Linked to Higher Veteran Participation in an Innovative VA-YMCA Wellness Clinic

Lead/Presenter: Alaina Preddie, 
All Authors: Preddie AK (EXTEND QUERI – Indianapolis), Williams C (EXTEND QUERI – Indianapolis) Miech E (EXTEND QUERI – Indianapolis) Williams L (EXTEND QUERI – Indianapolis) Damush T (EXTEND QUERI – Indianapolis)

Objectives:
In 2019, the Veterans Health Indiana (VHI) developed a multidisciplinary Wellness clinic in partnership with a local YMCA to comprehensively address Veterans’ chronic pain using a biopsychosocial framework. We evaluated clinic reach including which Veteran patients with chronic pain were associated with higher levels of engagement with the VHI Wellness Clinic.

Methods:
We applied configurational analysis to a Veteran sample who had their first visit to the VA-YMCA clinic in March-April 2019. Medical chart review was used to extract visit data, number of attended/missed visits, referral source, appointment types, pain scores, and demographics. The outcome of “high participation” was defined by Veterans completing a program or attending 5 or more appointments. The configurational analysis looked across 38 biopsychosocial factors to identify combinations of factors that distinguished Veterans with high participation (n = 161) from those without (n = 151). Semi-structured interviews were conducted with 8 veterans to assess perceived benefits of the Wellness Clinic.

Results:
The cohort included 312 Veterans with a mean age of 55.4 years, of which 83% were male. The final model included 6 factors: participation in physical therapy, pain psychology, or pain education sessions; presence of any “no-shows”; history of depression; and clinic referral source. These factors explained 60% of the cases in the higher-participation group with 86% consistency. The model consisted of 4 distinct pathways: combinations of 1) PT and pain education, 2) PT and pain psychology, 3) PT, zero “no-shows”, and no history of depression, and 4) referred from Primary Care or self-referral with zero “no-shows” and no history of depression. In interviews, veterans expressed the clinic location, provider communication, and pain relief were the most beneficial clinic aspects.

Implications:
Configurational analysis identified specific biopsychosocial factors and clinical services directly linked to higher Veteran participation in a new VA-YMCA wellness clinic.

Impacts:
VA-Community partnerships for Veteran pain education and therapy are convenient for Veterans and may enhance well-being. Configurational methods can help potentially address two challenges: determining how the joint presence of specific factors link directly to an outcome of interest, and how different solutions may identify unique subgroups within a given outcome of interest.