Health Services Research & Development

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FORUM - Translating research into quality health care for Veterans

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Director's Letter

David Atkins, M.D., M.P.H., Director, HSR&D

The current enthusiasm for "patient-centered care" (a recent Google search returns 6 million entries) can be confusing and off-putting to many clinicians. Confusing because it has been applied to a disparate set of care innovations, off-putting because it seems to imply that clinicians need to be reminded to care about their individual patients. VHA's new operational guide for moving towards focused Veteran-centric care, the "Blueprint for Excellence," describes "healthcare that is personalized, proactive, and patientdriven." I find this definition helpful because it identifies distinct actions that together put patients closer to the center of their care. First, patients need to determine what they want from their care and, then, work with their care team to devise a treatment plan matched to their specific desires, conditions, and abilities. As patients live longer and accumulate more chronic conditions (and often more providers), what is most important to them—which is often remaining independent and comfortable—may get lost or be in conflict with the disease-specific clinical goals of their clinicians.

One of the transformational actions envisioned by the Blueprint is for the Office of Patient Centered Care and Cultural Transformation to implement personalized health plans that clarify each Veteran's personal life priorities and goals for their health. These plans can then be used to coordinate care across different providers. The second element is to make our care more proactive, focusing upstream on how we can keep patients healthier rather than focusing all our attention after they become sick. This shift in focus will require engaging resources in the community, such as Veterans' service organizations as described in Jeff Whittle's article in this issue. The final element is transforming into a "patient-driven" model of care rather than one that revolves around the workflow of clinicians. This shift can entail everything from making the hospital environment more welcoming for patients and families; using mobile health to facilitate communication and scheduling; and most important, engaging patients in their own care, as described in several of the articles in this issue.

Engagement is not just about making patients feel better about their care—decades of research have shown that levels of patient activation or engagement are strong predictors of better health outcomes as well. The need for more engagement extends to research. In HSR&D, we have recently formed a patient-engagement workgroup which is charged with making recommendations to HSR&D leadership about how to increase the engagement of our Veterans in the research priorities we pursue. By increasing the "voice of the Veteran" in our research, we hope to increase the chances that providers will adopt the findings of that research more quickly, resulting in improvements that Veterans care about.

David Atkins, M.D., M.P.H., Director, HSR&D