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In this issue: Whole Health

Word cloud of whole health concepts

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From the HSR Director's Desk

Whole Health: The Time Has Come

Amy Kilbourne, PhD, MPH, Acting Director, Health Systems ResearchD Modern medical practice has made great discoveries that have saved countless lives but at the same time can lead us on a course of over-medicalizing individuals without considering their preferences, life goals, and ultimately, their humanity. As one of the largest single providers of medical care in the U.S., VA has been a national leader in the rapid scale-up of person-centered care—initially for mental health care and now more broadly through VA’s Whole Health program—especially under the leadership of the Office of Patient-Centered Care and Cultural Transformation. This growth has complemented similar trends in VA recovery-oriented mental health services, such as focusing on Veterans’ life goals beyond their immediate treatment needs and modeling an “athlete-coach” perspective in the patient-provider relationship.

Overall, research, in close partnership with VA operations leaders, has played a prominent role in the scale-up and spread of whole health best practices nationally, namely through the development of practice-based infrastructures, strong data curation of person-centered outcomes, and validation and deployment of change strategies to support provider uptake of whole health best practices. This strong researcher-clinical partnership has led to significant impacts in the way VA has provided comprehensive Veteran-centered care for pain management, PTSD, and complex chronic conditions and settings, most recently for homeless-experienced Veterans. Hand in hand with VA operational leaders, VA investigators are poised to further impact the care experience for Veterans, through national partnerships with DOD and NIH to conduct comprehensive pragmatic trials involving the Whole Health system of care on pain management, mental health, and conditions related to military exposures (e.g., COPD), and ultimately, through innovative programs and policies that address social determinants to optimize Veterans’ life goals and journey beyond the clinic walls, especially for at-risk and marginalized populations.
–Amy Kilbourne, PhD, MPH, Acting Director, Health Systems Research


The benefits of addressing “whole health” (WH) in healthcare have gained increased attention and support within VA. This holistic approach looks beyond symptoms and disease to also encompass patients’ goals, well-being, and social determinants of health (SDoH)—factors such as economic and housing stability, loneliness, discrimination, and healthcare access, which can influence health or even be the root cause of health problems.

VA’s Health Systems Research (HSR, formerly HSR&D) and Quality Enhancement Research Initiative (QUERI) work to build scientific evidence that supports VA’s transformation to a Whole Health system of care and informs VA’s WH treatments, programs, and policies. Investigators with HSR and QUERI assess ways to promote Veterans’ WH, develop effective interventions to optimize WH, and speed implementation of WH practices. Their work includes partnerships with diverse offices and programs across VA, such as the Office of Rural Health, the Office of Mental Health and Suicide Prevention, the Office of Patient Centered Care & Cultural Transformation, Women’s Health, Primary Care, and specialty care services such as cardiology and pulmonary medicine.

Measuring What Matters Most: Considering the Whole Person in Healthcare Research

Benjamin Kligler, MD, MPH, Executive Director, VA Office of Patient Centered Care & Cultural Transformation“The question ‘What’s the matter with you?’ has generally been the guiding principle in our find-it and fix-it problem-based approach to healthcare. Whole health shifts the focus to the question ‘What matters to you?’”
Benjamin Kligler, MD, MPH, Executive Director, VA Office of Patient Centered Care & Cultural Transformation

At a 2023 HSR State of the Art (SOTA) conference on “Measuring What Matters Most (M3): Whole Person Outcomes in Clinical Care, Research, and Population Health,” about 60 internal and external operations and research experts gathered to discuss current knowledge of whole person measures, and to identify a research agenda that closes research gaps and supports Veterans’ WH in clinical care and as a population. This includes examining well-being not only as an outcome, but as a moderator or mediator that might influence the effectiveness of disease interventions.

An upcoming HSR-sponsored supplement of the journal Medical Care will include findings from the SOTA conference and related research, plus perspectives from the broader field on how measurement of well-being and whole person outcomes can improve health and healthcare delivery.

What We’ve Done Lately

Recent impactful Whole Health research by HSR investigators includes:

QUERI works with stakeholders throughout VA to deploy and evaluate implementation and quality improvement strategies that optimize care for Veterans. QUERI projects related to WH include:

  • The Center for Evaluating Patient-Centered Care (EPCC-VA) examines the implementation and impact of VA’s transformation to a WH system of care.
  • The Complementary and Integrative Health Evaluation Center (CIHEC), in collaboration with VA’s Office of Patient Centered Care & Cultural Transformation, evaluates the implementation of evidence-based complementary and integrative therapies and the effectiveness of novel CIH therapies for Veterans and VA employees.
  • Bridge QUERI strives to help Veterans negotiate the care continuum, focusing on homelessness, the justice system, and substance abuse.
  • EMPOWER QUERI works to expand access to virtual, evidence-based, preventive and mental health services for women Veterans, focusing on heart disease, depression, and reproductive health.
  • Housing Transitions QUERI aims to support Veterans as they transition from VA residential programs to independent living.

What’s Upcoming

Ongoing HSR-funded research projects that target Whole Health include:

  • Evaluating the impact of WH coaching for Veterans with chronic pain and opioid dependence: The TEAMWORK trial. The intersecting problems of high-impact chronic pain and the opioid overdose crisis continue to be major public health concerns, yet few solutions to support comorbid chronic pain, opioid dependence, and opioid-related harms are available. This study, funded by the NIH-DOD-VA Pain Management Collaboratory, aims to evaluate the impact of WH coaching for Veterans with chronic pain and opioid dependence by comparing the effectiveness of treatment with usual care (pain management teams; PMT) with PMT treatment enhanced with WH coaching (PMT-WHC).
  • Assessing pain, patient reported outcomes, and complementary and integrative health: The APPROACH trial. This large-scale (n=18,000) trial is assessing the effectiveness of five types of CIH approaches on chronic pain and pain-related conditions among Veterans with chronic musculoskeletal pain. The study is being conducted at 18 VA WH flagship sites, in partnership with VA’s Office of Patient Centered Care & Cultural Transformation.
  • Optimizing the implementation of WH coaching for Veterans with COPD. A key component of VA’s WH system of care is WH coaching, which pairs Veterans with trained professionals who deliver one-on-one support for setting and achieving personally meaningful health and well-being goals. However, little guidance exists on WH coaching best practices for Veterans with complex clinical needs. This study is partnering with VA’s Office of Patient Centered Care & Cultural Transformation to explore how to optimize the implementation of WH coaching for Veterans with COPD, with the potential to improve the care and quality of life for this large Veteran population.
  • Developing a blueprint to implement WH clinical care for Veterans with HIV. Currently, implementation of VA’s WH system of care focuses on primary and mental healthcare. This study seeks to advance WH implementation guidance for specialty care services, particularly those for Veterans with HIV. Researchers will identify and work with HIV specialty care Veterans, providers, and leaders to co-design a WH implementation blueprint that can serve as an example for WH coordination across VA primary and specialty care settings.
  • Using data analytics and WH coaching to reduce frequent use of acute care among homeless Veterans. Homelessness is a robust social determinant of acute care use. This study aims to integrate use of data-driven processes with peer specialists trained in WH coaching to better tailor care for high-need, homeless Veterans in VHA and facilitate homeless Veterans’ engagement in supportive services to reduce their frequent reliance on acute care services.
  • Implementing a clinical-community partnered intervention to address food insecurity among high-risk Veterans. Nearly 25% of Veterans are estimated to be food insecure (FI), experiencing limited or uncertain access to nutritionally adequate and safe foods. This study aims to address knowledge gaps related to identification of FI Veterans in clinical settings, and FI Veterans’ interactions with VA and community resources. The project also intends to develop and pilot test an intervention model to optimize screening and referral for connecting FI Veterans to relevant resources.

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