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Health Services Research & Development

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IIR 16-254 – HSR&D Study

IIR 16-254
Development of a Patient-Reported Measure to Assess Healthcare Engagement
Rachel Kimerling PhD BA
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: April 2018 - March 2022

Enhancing engagement with health care is the foundation for VHA's transformation to personalized, proactive, patient-driven care that optimizes health and well-being. Patient engagement is linked to better care experiences and better clinical outcomes at reduced costs: the "triple aim" of healthcare systems. The science devoted to measurement must keep pace with new models of care. The ability to measure Veteran engagement is a critical component of patient-centered care. A self-report measure could be incorporated into patient-facing applications, inform personalized care plans and risk stratification, and facilitate research efforts. Extant measures do not meet VHA needs with respect to literacy levels, measurement sensitivity, or feasibility.

Our goal is to develop a Veteran-centered, precise, and predictive patient-reported measure that quantifies the propensity to engage with health care.
The aims of this project are to:
1) establish an item bank and corresponding short form that measures a Veteran's propensity to engage with health care;
2) assess concurrent validity and test-retest reliability of the measure;
3) evaluate the predictive validity of the new measure against objective indicators of patient engagement.

The item pool will be evaluated using a national survey of VHA primary care users who have been diagnosed with a mental health condition (depression or PTSD) or chronic medical condition (hypertension or diabetes), oversampling for women and racial minorities. Item Response Theory models will be used to calibrate items. Convergent validity with self-report correlates of patient engagement will provide preliminary validation. Predictive validity will be examined using global and condition-specific indicators of engagement from VA administrative data aggregated over the year following the survey.


High value care is determined by how well services fit with Veteran needs, preferences, and opportunities to benefit from care. A measure of engagement can help tailor care to Veteran needs and identify individuals who require adjunctive intervention to achieve the most benefit from their care. This research will fill an important gap in population health management, not only by enhancing risk prediction, but by integrating Veteran perspectives through patient-reported measures.


Journal Articles

  1. Farmer CC, Rossi FS, Michael EM, Kimerling R. Psychotherapy Utilization, Preferences, and Retention among Women Veterans with Post-traumatic Stress Disorder. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2020 Sep 1; 30(5):366-373.
  2. Haverfield MC, Tierney A, Schwartz R, Bass MB, Brown-Johnson C, Zionts DL, Safaeinili N, Fischer M, Shaw JG, Thadaney S, Piccininni G, Lorenz KA, Asch SM, Verghese A, Zulman DM. Can Patient-Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review. Journal of general internal medicine. 2020 Jul 1; 35(7):2107-2117.

DRA: none
DRE: Prevention, TRL - Applied/Translational
Keywords: none
MeSH Terms: none

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