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2023 HSR&D/QUERI National Conference Abstract

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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)

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.

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.

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.

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

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.