TY - JOUR
T1 - From patient outcomes to system change
T2 - Evaluating the impact of VHA's implementation of the Whole Health System of Care
AU - Bokhour, Barbara G.
AU - Hyde, Justeen
AU - Kligler, Benjamin
AU - Gelman, Hannah
AU - Gaj, Lauren
AU - Barker, Anna M.
AU - Douglas, Jamie
AU - DeFaccio, Rian
AU - Taylor, Stephanie L.
AU - Zeliadt, Steven B.
N1 - Funding Information:
This study was funded by the US Department of Veterans Affairs, Quality Enhancement Research Initiative and the VA's Office of Patient Centered Care and Cultural Transformation (PEC 13‐001). The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
Publisher Copyright:
Published 2022. This article is a U.S. Government work and is in the public domain in the USA.
PY - 2022/6
Y1 - 2022/6
N2 - Objective: To describe how a partnered evaluation of the Whole Health (WH) system of care—comprised of the WH pathway, clinical care, and well-being programs—produced patient outcomes findings, which informed Veterans Health Administration (VA) policy and system change. Data Sources: Electronic health records (EHR)-based cohort of 1,368,413 patients and a longitudinal survey of Veterans receiving care at 18 WH pilot medical centers. Study Design: In partnership with VA operations, we focused the evaluation on the impact of WH services utilization on Veterans' (1) use of opioids and (2) care experiences, care engagement, and well-being. Outcomes were compared between Veterans who did and did not use WH services identified from the EHR. Data Collection: Pharmacy records and WH service data were obtained from the VA EHR, including WH coaching, peer-led groups, personal health planning, and complementary, integrative health therapies. We surveyed veterans at baseline and 6 months to measure patient-reported outcomes. Principal Findings: Opioid use decreased 23% (31.5–6.5) to 38% (60.3–14.4) among WH users depending on level of WH use compared to a secular 11% (12.0–9.9) decrease among Veterans using Conventional Care. Compared to Conventional Care users, WH users reported greater improvements in perceptions of care (SMD = 0.138), engagement in health care (SMD = 0.118) and self-care (SMD = 0.1), life meaning and purpose (SMD = 0.152), pain (SMD = 0.025), and perceived stress (SMD = 0.191). Conclusions: Evidence developed through this partnership yielded key VA policy changes to increase Veteran access to WH services. Findings formed the foundation of a congressionally mandated report in response to the Comprehensive Addiction and Recovery Act, highlighting the value of WH and complementary, integrative health and well-being programs for Veterans with pain. Findings subsequently informed issuance of an Executive Decision Memo mandating the integration of WH into mental health and primary care across VA, now one lane of modernization for VA.
AB - Objective: To describe how a partnered evaluation of the Whole Health (WH) system of care—comprised of the WH pathway, clinical care, and well-being programs—produced patient outcomes findings, which informed Veterans Health Administration (VA) policy and system change. Data Sources: Electronic health records (EHR)-based cohort of 1,368,413 patients and a longitudinal survey of Veterans receiving care at 18 WH pilot medical centers. Study Design: In partnership with VA operations, we focused the evaluation on the impact of WH services utilization on Veterans' (1) use of opioids and (2) care experiences, care engagement, and well-being. Outcomes were compared between Veterans who did and did not use WH services identified from the EHR. Data Collection: Pharmacy records and WH service data were obtained from the VA EHR, including WH coaching, peer-led groups, personal health planning, and complementary, integrative health therapies. We surveyed veterans at baseline and 6 months to measure patient-reported outcomes. Principal Findings: Opioid use decreased 23% (31.5–6.5) to 38% (60.3–14.4) among WH users depending on level of WH use compared to a secular 11% (12.0–9.9) decrease among Veterans using Conventional Care. Compared to Conventional Care users, WH users reported greater improvements in perceptions of care (SMD = 0.138), engagement in health care (SMD = 0.118) and self-care (SMD = 0.1), life meaning and purpose (SMD = 0.152), pain (SMD = 0.025), and perceived stress (SMD = 0.191). Conclusions: Evidence developed through this partnership yielded key VA policy changes to increase Veteran access to WH services. Findings formed the foundation of a congressionally mandated report in response to the Comprehensive Addiction and Recovery Act, highlighting the value of WH and complementary, integrative health and well-being programs for Veterans with pain. Findings subsequently informed issuance of an Executive Decision Memo mandating the integration of WH into mental health and primary care across VA, now one lane of modernization for VA.
KW - evaluation design and research
KW - VA health care system
KW - health care organizations and systems
KW - health policy/politics/law/regulation
KW - patient assessment/satisfaction
UR - http://www.scopus.com/inward/record.url?scp=85125603105&partnerID=8YFLogxK
U2 - 10.1111/1475-6773.13938
DO - 10.1111/1475-6773.13938
M3 - Article
C2 - 35243621
AN - SCOPUS:85125603105
SN - 0017-9124
VL - 57
SP - 53
EP - 65
JO - Health Services Research
JF - Health Services Research
IS - S1
ER -