Health Services Research & Development

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FORUM - Translating research into quality health care for Veterans

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Research Highlight

The VA Blueprint for Excellence focuses on developing strategies for providing personalized, proactive, patient-driven care. This approach is not a new idea: VA has been moving in this direction for many years, having established the Office of Patient-Centered Care and Cultural Transformation in 2010 to move VA health care away from being disease-centered (i.e., "What is the matter with this patient?") to a patient-centered model of care (i.e., "What matters to this person?"). To be truly patientcentered, providers need to invite patients to engage in setting and attaining personal health goals. To that end, the Blueprint for Excellence calls for the implementation of personal health planning; such planning requires patients and providers to work collaboratively to create a plan of care that starts with the patient's goals, priorities, and preferences.

A personal health planning tool, the My Story: Personal Health Inventory (PHI), is being piloted in many VA medical centers throughout the country.1 The PHI was designed by the VA Office of Patient Centered Care and Cultural Transformation (OPCC&CT), based on the work of Dr. Tracy Gaudet, to assist in creating a partnership between Veterans and their health care providers. Using the PHI, Veterans choose health goals based on their own values and work with providers to implement goaloriented lifestyle changes.

The tool consists of a series of questions that encourage Veterans to reflect on multiple facets of health, referred to as the Components of Proactive Health and Well-Being. These components include: working the body; recharge; food and drink; personal development; family, friends, and co-workers; spirit and soul; surroundings; and power of the mind. The tool then asks the Veteran to:

1. Answer several overarching open-ended questions: "What really matters to you?" "What brings you joy and happiness?"

2. Rate his/her current physical well-being, emotional/mental well-being, and how it is to live his/her day-to-day life.

3. Think about each of the components of health and well-being, and state where he/ she is now, where he/she would like to be, and how he/she thinks he/she might achieve their goal.

4. Comment briefly about the preventive and clinical care they receive, and reflect on their vision of their best possible health, identifying any areas they would like to work on. The purpose is for the patient and practitioner together to use this information to identify a personal health goal and steps to reach that goal.

In partnership with OPCC&CT, the Center for Evaluating Patient-Centered Care in VA (EPCC-VA) investigators are evaluating the implementation and effects of PHI use. In our first study, we conducted qualitative analyses of Veterans' PHIs to develop a tool for coding patients' open-ended responses; this tool was then used to examine how Veterans respond to the questions.2 The distribution of codes found in 100 PHIs indicates that the tool is achieving its intended goal. Notably, Veterans' responses were coded most frequently as 'being with family,' 'sleep,' 'eating proper foods,' 'being healthy,' and 'social engagement,' whereas more medico-centric concerns such as adherence, medical issues, and even death were among the least coded responses.

In a second study, we examined perceptions and reactions to completing a PHI from data collected by OPCC&CT in listening sessions with both patients and providers at six pilot sites. We found that both groups viewed the PHI as helpful, allowing patients to self-reflect, providers to understand the patient's perspective, and bringing all providers onto the same page. The groups also noted that the tool is best used in conjunction with a health coach or provider who can build upon the responses.

We have also conducted surveys with Veterans who had documentation of completing a PHI. Preliminary analyses reveal that 1/3 of patients surveyed reported they had completed a PHI. Those who also set one or more personal health goals and reported engaging in activities to address those goals, reported better communication with their providers and better outcomes on several dimensions.

Many questions remain. We are conducting a mixed-methods national study of sites that have initiated personal health planning with Veterans. This study will identify differences in implementation, and examine patient-reported experiences with care and patient-reported outcomes. Initial data from one site which had done many PHIs with Veterans, indicates that successful use of the tool requires engagement of clinicians in changing the conversation.

How can we foster a truly Veteran-driven health care encounter, and ultimately a health care system that is responsive to what matters most to patients rather than one driven by a focus on disease? Personal health planning using the My Story: Personal Health Inventory tool encourages shared goal setting and improved self-management by engaging Veterans in their own care. Through our evaluation, the EPCC-VA team hopes to identify the strengths of this tool and better understand its implementation to ensure its success at sites throughout VA.

1. The PHI is available at www.va.gov/PATIENTCENTEREDCARE/mystory.asp.

2. Bokhour, B.G., Hogan, T.P., and Volkman, J.E., The Personal Health Inventory: An Analysis of Veteran Responses. VA White Paper, 2013.