4135 — Patient Satisfaction in the VHA Headache Centers of Excellence: A Cross-Sectional Cohort Study

Lead/Presenter: Addison Kimber,  Headache Centers of Excellence, Research and Evaluation Center
All Authors: Kimber AL (VA Headache Centers of Excellence, Research and Evaluation Center, West Haven, CT; Yale University), Fenton BT (VA Headache Centers of Excellence, Research and Evaluation Center) Lorenze NP (VA Headache Centers of Excellence, Research and Evaluation Center, Yale University SOM) Zhou B (VA Headache Centers of Excellence, Research and Evaluation Center, Yale University SOM) Sico JJ (VA Headache Centers of Excellence, Research and Evaluation Center, Yale University SOM) Seng EK (VA Headache Centers of Excellence, Research and Evaluation Center, Yeshiva University, Albert Einstein SOM)

Objectives:
Patient satisfaction is important for ensuring quality care and positive patient outcomes. This study compares patient satisfaction in Veterans Health Administration (VHA) Headache Centers of Excellence (HCoE) versus traditional headache care, and evaluates differences in satisfaction with headache care by demographic characteristics.

Methods:
In this cross-sectional cohort study we sent VHA Survey of Healthcare Experiences of Patients (SHEP) specialty care survey to veterans with a confirmed headache care visit from August 2022 to December 2022 in the VHA. Survey subjects were randomly selected from those who were seen by (1) an HCoE provider (HCoE patients); (2) a non-HCoE provider within a medical center with an HCoE (HCoE station patients), and; (3) a provider in a medical center without an HCoE (non-HCoE patients). Women veterans were oversampled. We used unadjusted and adjusted (by all demographics and HCoE Group) logistic regression models to evaluate differences in the highest level of satisfaction on SHEP composite domains (Access, Communication, Coordination, and Office Staff (each with a composite rating of 4 out of 4)) and two single-item measures (Provider Rating (rating of 9-10 out of 10) and Overall Satisfaction (rating of 5-6 out of 6)).

Results:
4,317 patients responded (14.8% total response rate, 605 HCoE patients (16.1% response), 1429 HCoE station patients (14.1% response), and 2283 non-HCoE patients (13.5% response)). HCoE patients had higher Overall Satisfaction (OR = 1.29, 95% CI 1.08-1.54) and Provider Ratings (OR = 1.35, 95% CI 1.14-1.60), as well as higher satisfaction in Access (OR = 1.46, 95% CI 1.19-1.79) and Communication (OR = 1.33, 95% CI 1.06-1.66) than non-HCoE patients. Patients seen in a station with an HCoE had higher satisfaction across all domains (Access OR = 1.34, 95% CI 1.28-1.39; Communication OR = 1.36, 95% CI 1.30-1.41; Care Coordination OR 1.36, 95% CI 1.31-1.42; Staff OR 1.24, 95% CI 1.20-1.27; Overall Satisfaction OR 1.49, 95% CI 1.42-1.56; Provider Rating OR 1.23, 95% CI 1.18-1.28). Overall Satisfaction and Provider Rating were significantly lower in African American (OR 0.94, 95% CI 0.90-0.99; OR 0.90, 95% CI 0.87-0.94) and Asian respondents (OR 0.77, 95% CI 0.68-0.88; OR 0.73, 95% CI 0.66-0.82) compared to White respondents, although these results were attenuated with adjustment. Care coordination scores were lower in Asian (OR 0.64, 95% CI 0.55-0.74) American Indian/Alaska Native (OR 0.34, 95% CI 0.28-0.41), and Native Hawaiian/Pacific Islanders (OR 0.77, 95% CI 0.70-0.85) compared to White respondents.

Implications:
HCoE patients and HCoE station patients reported greater satisfaction across all domains except care coordination and office staff. Overall satisfaction, provider ratings, and satisfaction with care coordination were lower for most racial groups before and after adjustment. Determining whether educational efforts from HCoEs contributed to the improvement of care satisfaction in stations with an HCoE is warranted.

Impacts:
Opportunities exist to improve patient experience with headache care, specifically for medical centers without an HCoE and among minority groups. Expansion of the HCoEs and tailoring headache care plans may be another useful tool for improving patient experiences.