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O’Hanlon CE, Zeliadt SB, DeFaccio R, Gaj L, Bokhour BG, Taylor SL. Patient-reported pain and physical health for acupuncture and chiropractic care delivered by Veterans Affairs versus community providers. PLoS One 2024; 19:e0303651. [PMID: 38748671 PMCID: PMC11095679 DOI: 10.1371/journal.pone.0303651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Acupuncture and chiropractic care are evidence-based pain management alternatives to opioids. The Veterans Health Administration (VA) provides this care in some VA facilities, but also refers patients to community providers. We aimed to determine if patient-reported outcomes differ for acupuncture and chiropractic care from VA versus community providers. MATERIALS AND METHODS We conducted an observational study using survey outcome data and electronic medical record utilization data for acupuncture and chiropractic care provided in 18 VA facilities or in community facilities reimbursed by VA. Study participants were users of VA primary care, mental health, pain clinic, complementary and integrative therapies, coaching or education services in 2018-2019. Patients received 1) 4+ acupuncture visits (N = 201) or 4+ chiropractic care visits (N = 178) from a VA or community provider from 60 days prior to baseline to six-months survey and 2) no acupuncture or chiropractic visits from 1 year to 60 days prior to baseline. Outcomes measured included patient-reported pain (PEG) and physical health (PROMIS) at baseline and six-month surveys. Multivariate analyses examined outcomes at six months, adjusting for baseline outcomes and demographics. RESULTS In unadjusted analyses, pain and physical health improved for patients receiving community-based acupuncture, while VA-based acupuncture patients experienced no change. Unadjusted analyses also showed improvements in physical health, but not pain, for patients receiving VA-based chiropractic care, with no changes for community-based chiropractic care patients. Using multivariate models, VA-based acupuncture was no different from community-based acupuncture for pain (-0.258, p = 0.172) or physical health (0.539, p = 0.399). Similarly, there were no differences between VA- and community-based chiropractic care in pain (-0.273, p = 0.154) or physical health (0.793, p = 0.191). CONCLUSIONS Acupuncture and chiropractic care were associated with modest improvements at six months, with no meaningful differences between VA and community providers. The choice to receive care from VA or community providers could be based on factors other than quality, like cost or convenience.
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Affiliation(s)
- Claire E. O’Hanlon
- Veterans Affairs Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, California, United States of America
- RAND Corporation, Santa Monica, California, United States of America
| | - Steven B. Zeliadt
- Veterans Affairs Puget Sound Health Care System, VA Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, United States of America
- Department of Health Systems and Population Health, Hans Rosling Center for Population Health, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Rian DeFaccio
- Veterans Affairs Puget Sound Health Care System, VA Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington, United States of America
| | - Lauren Gaj
- VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, Massachusetts, United States of America
| | - Barbara G. Bokhour
- VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, Massachusetts, United States of America
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
| | - Stephanie L. Taylor
- Veterans Affairs Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, California, United States of America
- Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, California, United States of America
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
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2
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Van Houtven CH, Smith VA, Miller KEM, Berkowitz TSZ, Shepherd-Banigan M, Hein T, Penney LS, Allen KD, Kabat M, Jobin T, Hastings SN. Comprehensive Caregiver Supports and Ascertainment and Treatment of Veteran Pain. Med Care Res Rev 2024; 81:107-121. [PMID: 38062735 DOI: 10.1177/10775587231210026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Disabled Veterans commonly experience pain. The Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides training, a stipend, and services to family caregivers of eligible Veterans to support their caregiving role. We compared ascertainment of veteran pain and pain treatment through health care encounters and medications (pain indicators) of participants (treated group) and non-participants (comparison group) using inverse probability treatment weights. Modeled results show that the proportion of Veterans with a pain indicator in the first year post-application was higher than that pre-application for both groups. However, the proportion of Veterans with a pain indicator was substantially higher in the treatment group: 76.1% versus 63.9% in the comparison group (p < .001). Over time, the proportion of Veterans with any pain indicator fell and group differences lessened. However, differences persisted through 8 years post-application (p < .001). PCAFC caregivers appear to help Veterans engage in pain treatment at higher rates than caregivers not in PCAFC.
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Affiliation(s)
- Courtney H Van Houtven
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
- Department of Population Health Sciences, Duke University School of Medicine
- Duke Margolis Center for Health Policy, Duke University
| | - Valerie A Smith
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
- Department of Population Health Sciences, Duke University School of Medicine
- Department of General Internal Medicine, Duke University
| | - Katherine E M Miller
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
- Department of Medical Ethics and Health Policy, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Theodore S Z Berkowitz
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
| | - Megan Shepherd-Banigan
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
- Department of Population Health Sciences, Duke University School of Medicine
| | - Tyler Hein
- Office of Mental Health and Suicide Prevention, Department of Veterans Affairs
| | - Lauren S Penney
- The Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System
- Department of Medicine, Division of Hospital Medicine, University of Texas Health San Antonio
| | - Kelli D Allen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
- Department of Medicine, University of North Carolina at Chapel Hill
| | - Margaret Kabat
- Office of the Secretary US Department of Veterans Affairs
| | - Timothy Jobin
- Caregiver Support Program, Veterans Health Administration, US Department of Veterans Affairs
| | - S Nicole Hastings
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System
- Department of Population Health Sciences, Duke University School of Medicine
- Department of Medicine, Division of Geriatrics, Duke University School of Medicine
- Center for the Study of Aging and Human Development, Duke University School of Medicine
- Geriatrics Research, Education and Clinical Center, Durham VA Health Care System
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3
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Lewinski AA, Shapiro A, Crowley MJ, Whitfield C, Jones JR, Jeffreys AS, Coffman CJ, Howard T, McConnell E, Tanabe P, Barcinas S, Bosworth HB. Diabetes distress in Veterans with type 2 diabetes mellitus: Qualitative descriptive study. J Health Psychol 2024:13591053241233387. [PMID: 38384142 DOI: 10.1177/13591053241233387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Diabetes distress (DD) is a negative psychosocial response to living with type 2 diabetes mellitus (T2DM). We sought insight into Veterans' experiences with DD in the context of T2DM self-management. The four domains in the Diabetes Distress Scale (i.e. regimen, emotional, interpersonal, healthcare provider) informed the interview guide and analysis (structural coding using thematic analysis). The mean age of the cohort (n = 36) was 59.1 years (SD 10.4); 8.3% of patients were female and 63.9% were Black or Mixed Race; mean A1C was 8.8% (SD 2.0); and mean DDS score was 2.4 (SD 1.1), indicating moderate distress. Veterans described DD and challenges to T2DM self-management across the four domains in the Diabetes Distress Scale. We found that (1) Veterans' challenges with their T2DM self-management routines influenced DD and (2) Veterans experienced DD across a wide range of domains, indicating that clinical interventions should take a "whole-person" approach.Trial Registration: NCT04587336.
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Affiliation(s)
- Allison A Lewinski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Abigail Shapiro
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
| | - Matthew J Crowley
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Chelsea Whitfield
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
| | - Joanne Roman Jones
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Department of Nursing, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Amy S Jeffreys
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
| | - Cynthia J Coffman
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Teresa Howard
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
| | - Eleanor McConnell
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Geriatric Research, Education and Clinical Center (GRECC), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Paula Tanabe
- Duke University School of Nursing, Durham, NC, USA
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Susan Barcinas
- College of Education, North Carolina State University, Raleigh, NC, USA
| | - Hayden B Bosworth
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation Durham Veterans Health Care System, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Courtney RE, Schadegg MJ, Bolton R, Smith S, Harden SM. Using a Whole Health Approach to Build Biopsychosocial-Spiritual Personal Health Plans for Veterans with Chronic Pain. Pain Manag Nurs 2024; 25:69-74. [PMID: 37839983 DOI: 10.1016/j.pmn.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/08/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
Chronic pain affects over 50 million Americans per year and costs society billions of dollars annually. It is widely accepted that the biomedical model is outdated and research on the biopsychosocial model of chronic pain has increased in recent years, concurrent with investigations into self-management of chronic pain. The Veterans Health Administration (VHA) has incorporated both of these approaches into their Whole Health System. This work describes the VHA Whole Health System, reviews the literature on alignment between the Whole Health System's Circle of Health and chronic pain, and explains how the VHA Whole Health model may be used as a method for organizing self-management strategies within a personal health plan in the context of chronic pain. Given the infusion of nurses throughout the healthcare system, nurses are in a unique position to champion this biopsychosocial-spiritual approach to care.
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Affiliation(s)
- Rena E Courtney
- PREVAIL Center for Chronic Pain, Salem, VA Health Care System, Salem, Virginia; Virginia Tech Carilion School of Medicine, Salem, Virginia.
| | - Mary J Schadegg
- NYU Grossman School of Medicine/NYU Langone Health, New York, New York
| | - Rendelle Bolton
- Center for Healthcare Organization and Implementation Research, Bedford VA Health Care System, Bedford, Massachusetts
| | - Stephanie Smith
- PREVAIL Center for Chronic Pain, Salem, VA Health Care System, Salem, Virginia
| | - Samantha M Harden
- Virginia Tech Carilion School of Medicine, Salem, Virginia; Virginia Tech, Blacksburg, Virginia
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Haderlein TP, Guzman-Clark J, Dardashti NS, McMahon N, Duran EL, Haun JN, Robinson SA, Blok AC, Cutrona SL, Lindsay JA, Armstrong CM, Nazi KM, Shimada SL, Wilck NR, Reilly E, Kuhn E, Hogan TP. Improving Veteran Engagement with Virtual Care Technologies: a Veterans Health Administration State of the Art Conference Research Agenda. J Gen Intern Med 2024; 39:21-28. [PMID: 38252243 PMCID: PMC10937853 DOI: 10.1007/s11606-023-08488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/13/2023] [Indexed: 01/23/2024]
Abstract
Although the availability of virtual care technologies in the Veterans Health Administration (VHA) continues to expand, ensuring engagement with these technologies among Veterans remains a challenge. VHA Health Services Research & Development convened a Virtual Care State of The Art (SOTA) conference in May 2022 to create a research agenda for improving virtual care access, engagement, and outcomes. This article reports findings from the Virtual Care SOTA engagement workgroup, which comprised fourteen VHA subject matter experts representing VHA clinical care, research, administration, and operations. Workgroup members reviewed current evidence on factors and strategies that may affect Veteran engagement with virtual care technologies and generated key questions to address evidence gaps. The workgroup agreed that although extensive literature exists on factors that affect Veteran engagement, more work is needed to identify effective strategies to increase and sustain engagement. Workgroup members identified key priorities for research on Veteran engagement with virtual care technologies through a series of breakout discussion groups and ranking exercises. The top three priorities were to (1) understand the Veteran journey from active service to VHA enrollment and beyond, and when and how virtual care technologies can best be introduced along that journey to maximize engagement and promote seamless care; (2) utilize the meaningful relationships in a Veteran's life, including family, friends, peers, and other informal or formal caregivers, to support Veteran adoption and sustained use of virtual care technologies; and (3) test promising strategies in meaningful combinations to promote Veteran adoption and/or sustained use of virtual care technologies. Research in these priority areas has the potential to help VHA refine strategies to improve virtual care user engagement, and by extension, outcomes.
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Affiliation(s)
- Taona P Haderlein
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, Los Angeles, CA, USA.
- Department of Veterans Affairs, Veterans Emergency Management Evaluation Center, Sepulveda, CA, USA.
| | | | - Navid S Dardashti
- NYU Grossman School of Medicine, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY, USA
| | - Nicholas McMahon
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | | | - Jolie N Haun
- Research and Development Service, James A. Haley Veterans Hospital, Tampa, FL, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Amanda C Blok
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States Department of Veterans Affairs, Ann Arbor, MI, USA
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jan A Lindsay
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- Rice University's Baker Institute for Public Policy, Houston, TX, USA
| | - Christina M Armstrong
- Connected Health Implementation Strategies, Office of Connected Care, Veterans Health Administration, Washington, DC, USA
| | - Kim M Nazi
- Trilogy Federal, LLC, Arlington, VA, USA
- KMN Consulting Services, LTD, Coxsackie, NY, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nancy R Wilck
- Connected Health Implementation Strategies, Office of Connected Care, Veterans Health Administration, Washington, DC, USA
| | - Erin Reilly
- VISN 1 Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Eric Kuhn
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Peter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
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Kroll-Desrosiers A, Wallace KF, Higgins DM, Martino S, Mattocks KM. Musculoskeletal Pain During Pregnancy Among Veterans: Associations With Health and Health Care Utilization. Womens Health Issues 2024; 34:90-97. [PMID: 37580185 DOI: 10.1016/j.whi.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Musculoskeletal (MSK) pain is more likely to be diagnosed in veterans compared with the general population; however, MSK pain during pregnancy has not been studied in veterans. This study examined health and health care use differences between pregnant veterans with and without MSK pain (MSK-). METHODS Veterans who delivered a newborn before June 1, 2021, were identified from an existing cohort (n = 1,181). Survey and Veterans Health Administration (VA) electronic health record data were obtained on participants. Veterans meeting inclusion criteria were identified as those with MSK pain (MSK+) and were compared with MSK- participants. We examined differences between primary outcomes of VA health care engagement (including mental health diagnoses, health care visits, receipt of prescription opioids, and complementary and integrative health use) and secondary outcomes (including postpartum variables) between MSK pain groups. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS There were 172 veterans (14.6%) who met MSK pain eligibility criteria. In adjusted models, MSK+ veterans were more likely to be diagnosed with major depressive disorder (aOR, 1.76; 95% CI, 1.22-2.53) and post-traumatic stress disorder (aOR, 1.79; 95% CI, 1.21-2.64) during pregnancy compared with MSK- veterans. The use of VA mental health care (aOR, 1.52; 95% CI, 1.09-2.12) and the odds of receiving an opioid prescription during pregnancy (aOR, 2.76; 95% CI, 1.53-5.00) was higher in MSK+ veterans compared with MSK- veterans. Only a small proportion (3.6%) of our entire cohort used complementary and integrative health approaches during pregnancy. MSK+ veterans were more likely to deliver by cesarean section compared with MSK- veterans (36% vs. 26%). CONCLUSIONS MSK+ veterans were more likely to be diagnosed with mental health conditions and to use VA mental health care during pregnancy compared with MSK- veterans. Because veterans receive their obstetrical care in the community, understanding the unique needs of pregnant MSK+ veterans in comparison with MSK- veterans is important to provide comprehensive care during the perinatal period.
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Affiliation(s)
- Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
| | - Kate F Wallace
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | - Diana M Higgins
- VA Durham Healthcare System, Durham, North Carolina; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Bokhour BG, DeFaccio R, Gaj L, Barker A, Deeney C, Coggeshall S, Gelman H, Taylor SL, Thomas E, Zeliadt SB. Changes in Patient-Reported Outcomes Associated with Receiving Whole Health in the Veteran Health Administration (VHA)'s National Demonstration Project. J Gen Intern Med 2024; 39:84-94. [PMID: 37653207 PMCID: PMC10817883 DOI: 10.1007/s11606-023-08376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Whole Health (WH) is a patient-centered model of care being implemented by the Veterans Health Administration. Little is known about how use of WH services impacts patients' health and well-being. OBJECTIVE We sought to assess the association of WH utilization with pain and other patient-reported outcomes (PRO) over 6 months. DESIGN A longitudinal observational cohort evaluation, comparing changes in PRO surveys for WH users and Conventional Care (CC) users. Inverse probability of treatment weighting was used to balance the two groups on observed demographic and clinical characteristics. PARTICIPANTS A total of 9689 veterans receiving outpatient care at 18 VA medical centers piloting WH. INTERVENTIONS WH services included goal-setting clinical encounters, Whole Health coaching, personal health planning, and well-being services. MAIN OUTCOME MEASURES The primary outcome was change in pain intensity and interference at 6 months using the 3-item PEG. Secondary outcomes included satisfaction, experiences of care, patient engagement in healthcare, and well-being. KEY RESULTS By 6 months,1053 veterans had utilized WH and 3139 utilized only CC. Baseline pain PEG scores were 6.2 (2.5) for WH users and 6.4 (2.3) for CC users (difference p = 0.028), improving by - 2.4% (p = 0.006) and - 2.3% (p < 0.001), respectively. In adjusted analyses, WH use was unassociated with greater improvement in PEG scores compared to CC - 1.0% (- 2.9%, 1.2%). Positive trends were observed for 8 of 15 exploratory outcomes for WH compared to CC. WH use was associated with greater improvements at 6 months in likelihood to recommend VA 2.0% (0.9%, 3.3%); discussions of goals 11.8% (8.2%, 15.5%); perceptions of healthcare interactions 2.5% (0.4%, 4.6%); and engagement in health behaviors 2.2% (0.3%, 3.9%). CONCLUSION This study provides early evidence supporting the delivery of WH patient-centered care services to improve veterans' experiences of and engagement in care. These are important first-line impacts towards the goals of better overall health and well-being outcomes for Veterans.
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Affiliation(s)
- Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Rian DeFaccio
- VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Lauren Gaj
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Anna Barker
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Christine Deeney
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Scott Coggeshall
- VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Hannah Gelman
- VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Stephanie L Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Medicine, Department of Health Policy and Management, UCLA, Los Angeles, CA, USA
| | - Eva Thomas
- VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Steven B Zeliadt
- VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
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von Schoen-Angerer T, Manchanda RK, Lloyd I, Wardle J, Szöke J, Benevides I, Martinez NSA, Tolo F, Nicolai T, Skaling-Klopstock C, Parker T, Suswardany DL, van Haselen R, Liu J. Traditional, complementary and integrative healthcare: global stakeholder perspective on WHO's current and future strategy. BMJ Glob Health 2023; 8:e013150. [PMID: 38050407 PMCID: PMC10693890 DOI: 10.1136/bmjgh-2023-013150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023] Open
Abstract
As the 'WHO Traditional Medicine Strategy: 2014-2023' is entering its final phase, reflection is warranted on progress and the focus for a new strategy. We used WHO documentation to analyse progress across the objectives of the current strategy, adding the role of traditional, complementary and integrative healthcare (TCIH) to address specific diseases as a dimension absent in the current strategy. Our analysis concludes on five areas. First, TCIH research is increasing but is not commensurate with TCIH use. TCIH research needs prioritisation and increased funding in national research policies and programmes. Second, WHO guidance for training and practice provides useful minimum standards but regulation of TCIH practitioners also need to reflect the different nature of formal and informal practices. Third, there has been progress in the regulation of herbal medicines but TCIH products of other origin still need addressing. A risk-based regulatory approach for the full-range of TCIH products seems appropriate and WHO should provide guidance in this regard. Fourth, the potential of TCIH to help address specific diseases is often overlooked. The development of disease strategies would benefit from considering the evidence and inclusion of TCIH practices, as appropriate. Fifth, inclusion of TCIH in national health policies differs between countries, with some integrating TCIH practices and others seeking to restrict them. We encourage a positive framework in all countries that enshrines the role of TCIH in the achievement of universal health coverage. Finally, we encourage seeking the input of stakeholders in the development of the new WHO Traditional Medicine Strategy.
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Affiliation(s)
- Tido von Schoen-Angerer
- International Federation of Anthroposophic Medical Associations, Brussels, Belgium
- Division of General Pediatrics, Geneva University Hospitals, Geneve, Switzerland
| | - Raj Kumar Manchanda
- Health and Family Welfare Department, Government of Delhi, Directorate of Ayush, Delhi, India
| | - Iva Lloyd
- World Naturopathic Federation, Toronto, Ontario, Canada
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, New South Wales, Australia
| | - Janka Szöke
- International Federation of Anthroposophic Medical Associations, Brussels, Belgium
| | - Iracema Benevides
- RedePICS Brasil, Brazilian Network of Integrative and Complementary Practices in Healthcare, Belo Horizonte, Brazil
| | | | - Festus Tolo
- Keny Medical Research Institute, Nairobi, Kenya
| | | | | | - Tabatha Parker
- Academy of Integrated Health and Medicine, La Jolla, California, USA
| | - Dwi Linna Suswardany
- Indonesian Public Health Association, Jakarta, Indonesia
- Department of Public Health, University of Muhammadiyah Surakarta, Jakarta, Indonesia
| | | | - Jianping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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9
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Bolton RE, Mohr DC, Charns M, Herbst AN, Bokhour BG. Creating Whole Person Health Care Systems: Understanding Employee Perceptions of VAs Whole Health Cultural Transformation. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:813-821. [PMID: 37935016 DOI: 10.1089/jicm.2023.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Objective: Whole person health care, like that being implemented in the U.S. Veterans Health Administration (VHA), involves person-centered approaches that address what matters most to patients to achieve well-being beyond the biomedical absence of disease. As whole health (WH) approaches expand, their integration into clinical practice is predicated on health care employees reconceptualizing practice beyond find-it-fix-it medicine and embracing WH as a new philosophy of care. This study examined employee perspectives of WH and their integration of this approach into care. Design: We conducted a survey with responses from 1073 clinical and 800 nonclinical employees at 5 VHA WH Flagship sites about their perceptions and use of a WH approach. We used descriptive statistics to examine employees' support for WH and conducted thematic analysis to qualitatively explore their perceptions about this approach from free-text comments supplied by 475 respondents. Results: On structured survey items, employees largely agreed that WH was a valuable approach but were relatively less likely to have incorporated it into practice or report support within their organization for WH. Qualitative comments revealed varying conceptualizations of WH. While some respondents understood that WH represented a philosophical shift in care, many characterized WH narrowly as services. These conceptualizations contributed to lower perceived relevance, skepticism, and misgivings that WH diverted needed resources away from existing clinical services. Organizational context including leadership messaging, siloed structures, and limited educational opportunities reinforced these perceptions. Conclusions: Successfully transforming the culture of care requires a shift in mindset among employees and leadership alike. Employees' depictions didn't always reflect WH as a person-centered approach designed to engage patients to enhance their health and well-being. Without consistent leadership messaging and accessible training, opportunities to expand understandings of WH are likely to be missed. To promote WH transformation, additional attention is needed for employees to embrace this approach to care.
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Affiliation(s)
- Rendelle E Bolton
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Health Law, Policy, and Management Department, Boston University School of Public Health, Boston, MA, USA
| | - Martin Charns
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Health Law, Policy, and Management Department, Boston University School of Public Health, Boston, MA, USA
| | - Abigail N Herbst
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Kligler B, Khung M, Schult T, Whitehead A. What We Have Learned About the Implementation of Whole Health in the Veterans Administration. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:774-780. [PMID: 36445191 DOI: 10.1089/jicm.2022.0753] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
As we have advanced the concept of Whole Health (WH) in the Veterans Administration over the past 10 years, we have had the unique advantage of working in a health care system in which a wide range of WH services-ranging from acupuncture to coaching to yoga and Tai Chi to nutrition classes to peer-facilitated empowerment and skill-building groups-are fully covered by the system as part of standard medical benefits. This has given us the opportunity to evaluate both the process and the outcomes of offering this type of Whole Person care on a system-wide scale. This article will review some of the lessons learned from that ongoing evaluation process in the areas of integration of complementary/integrative health approaches as well as health coaching and peer-led groups, WH education, employee well-being, cost impacts, and whole-system transformation. This is not a systematic review, as we will touch on numerous questions and lessons learned rather than dive deeply into the literature seeking the answer to one narrower question. Hopefully the narrative review approach taken here will stimulate further discussion in the field regarding what we are learning and what we can continue to learn from this large scale innovation.
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Affiliation(s)
- Benjamin Kligler
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
- Department of Family and Community Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maureen Khung
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
| | - Tamara Schult
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
| | - Alison Whitehead
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, USA
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Park LS, Kornfield R, Yezihalem M, Quanbeck A, Mellinger J, German M. Testing a Digital Health App for Patients With Alcohol-Associated Liver Disease: Mixed Methods Usability Study. JMIR Form Res 2023; 7:e47404. [PMID: 37966869 PMCID: PMC10687677 DOI: 10.2196/47404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Alcohol-associated liver disease (ALD) is increasingly common and associated with serious and costly health consequences. Cessation of drinking can improve ALD morbidity and mortality; however, support for cessation is not routinely offered to those diagnosed with ALD, and continued drinking or resumption of drinking after diagnosis is common. Mobile health (mHealth) has the potential to offer convenient and scalable support for alcohol cessation to those diagnosed with ALD, but mHealth interventions for alcohol cessation have not been designed for or evaluated in a population with ALD. OBJECTIVE This study aims to understand how individuals with ALD would perceive and use an mHealth tool for alcohol cessation and to gather their perspectives on potential refinements to the tool that would allow it to better meet their needs. METHODS We interviewed 11 individuals who attended clinic visits related to their ALD to elicit their needs related to support for alcohol cessation and views on how mHealth could be applied. After completing initial interviews (pre), participants were provided with access to an mHealth app designed for alcohol cessation, which they used for 1 month. Afterward, they were interviewed again (post) to give feedback on their experiences, including aspects of the app that met their needs and potential refinements. We applied a mixed methods approach, including a qualitative analysis to identify major themes from the interview transcripts and descriptive analyses of use of the app over 1 month. RESULTS First, we found that a diagnosis of ALD is perceived as a motivator to quit drinking but that patients had difficulty processing the overwhelming amount of information about ALD they received and finding resources for cessation of alcohol use. Second, we found that the app was perceived as usable and useful for supporting drinking recovery, with patients responding favorably to the self-tracking and motivational components of the app. Finally, patients identified areas in which the app could be adapted to meet the needs of patients with ALD, such as providing information on the medical implications of an ALD diagnosis and how to care for their liver as well as connecting individuals with ALD to one another via a peer-to-peer support forum. Rates of app use were high and sustained across the entire study, with participants using the app a little more than half the days during the study on average and with 100% (11/11) of participants logging in each week. CONCLUSIONS Our results highlight the need for convenient access to resources for alcohol cessation after ALD diagnosis and support the potential of an mHealth approach to integrate recovery support into care for ALD. Our findings also highlight the ways the alcohol cessation app should be modified to address ALD-specific concerns.
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Affiliation(s)
- Linda S Park
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Rachel Kornfield
- Preventive Medicine (Behavioral Medicine), Feinberg School of Medicine, Northwestern University, Evanston, IL, United States
| | | | - Andrew Quanbeck
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Jessica Mellinger
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Margarita German
- Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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Krist AH, South Paul JE, Hudson SV, Meisnere M, Singer SJ, Kudler H. Rethinking Health and Health Care: How Clinicians and Practice Groups Can Better Promote Whole Health and Well-Being for People and Communities. Med Clin North Am 2023; 107:1121-1144. [PMID: 37806727 DOI: 10.1016/j.mcna.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
A new National Academies of Sciences, Engineering, and Medicine report, "Achieving Whole Health: A New Approach for Veterans and the Nation," redefines what it means to be healthy and creates a roadmap for health systems, including the Veterans Health Administration and the nation, to scale and spread a whole health approach to care. The report identifies 5 foundational elements for whole health care and sets 6 national, state, and local policy goals for change. This article summarizes the report, emphasizes the importance of preventive medicine, and identifies concrete actions clinicians and practices can take now to deliver whole health care.
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Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Wright Regional Center for Clinical and Translational Science, Inova Health System.
| | | | - Shawna V Hudson
- Department of Family Medicine and Community Health, Robert Wood Johnson Medical School
| | - Marc Meisnere
- National Academies of Sciences, Engineering, and Medicine
| | - Sara J Singer
- Department of Medicine, Stanford University School of Medicine
| | - Harold Kudler
- Department of Psychiatry and Behavioral Sciences, Duke University; Department of Psychiatry, Uniformed Services University of the Health Sciences
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Etingen B, Smith BM, Zeliadt SB, Kaitz JE, Barker AM, Hyde JK, Fix GM, Reed DE, Anderson E, Hogan TP, Bokhour BG. VHA Whole Health Services and Complementary and Integrative Health Therapies: a Gateway to Evidence-Based Mental Health Treatment. J Gen Intern Med 2023; 38:3144-3151. [PMID: 37442899 PMCID: PMC10651564 DOI: 10.1007/s11606-023-08296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/16/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Engagement in evidence-based psychotherapy (EBP) among veterans with behavioral health conditions is often low. The Veterans Health Administration (VHA) is implementing a "Whole Health (WH)" system of care, to identify veteran personal health goals, align care with those goals, and offer services designed to engage and empower veterans to achieve well-being. OBJECTIVE To examine the relationship between veteran WH utilization and subsequent engagement in EBP. DESIGN Retrospective analysis of VHA administrative records from 18 facilities implementing WH. SUBJECTS Veterans (n = 265,364) with a diagnosis of depression, post-traumatic stress disorder (PTSD), and/or anxiety who had a mental healthcare encounter but no EBP use in fiscal year (FY) 2018. Among this cohort, 33,146 (12.5%) began using WH in FY2019. MAIN MEASURES We examined use of an EBP for depression, anxiety, and/or PTSD within 1 year of the index date of WH use compared to use of an EBP anytime during FY2019 for veterans not identified as using WH. We used multiple logistic regression to examine the association between veteran WH use and EBP engagement. KEY RESULTS Approximately 3.0% (n = 7,860) of the veterans in our overall cohort engaged in an EBP in the year following their index date. Controlling for key demographic, health, and utilization variables, WH users had 2.4 (95% CI: 2.2-2.5) times higher odds of engaging in an EBP the following year than those with no WH utilization. Associations between utilization of specific WH services (vs. no utilization of that service) and engagement in an EBP in the subsequent year ranged from 1.6 (95% CI: 1.0-2.6) to 3.5 (95% CI: 3.2-3.9) across the different types of WH services used. CONCLUSIONS WH use was associated with increased engagement in EBPs among veterans with depression, anxiety, and/or PTSD. Future interventions intended to promote veteran engagement in EBPs may benefit from leveraging WH services and therapies.
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Affiliation(s)
- Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA.
| | - Bridget M Smith
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Steven B Zeliadt
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
- University of Washington School of Public Health, Seattle, WA, USA
| | - Jenesse E Kaitz
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Anna M Barker
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Justeen K Hyde
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - David E Reed
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Gantt CJ, Donovan N, Khung M. Veterans Affairs' Whole Health System of Care for Transitioning Service Members and Veterans. Mil Med 2023; 188:28-32. [PMID: 37665587 DOI: 10.1093/milmed/usad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/10/2023] [Accepted: 02/07/2023] [Indexed: 09/05/2023] Open
Abstract
The Department of Veterans Affairs (VA) has launched an organization-wide transformation to a Whole Health System of Care that will ideally begin at the time of transition from active duty through the end of a Veteran's life. A brief history and overview of the Whole Health approach are provided along with selected evaluation results and planned initial actions as a result of the Total Force Fitness-Whole Health Summit held in March 2022. More work is required to strengthen the natural linkages between the Department of Defense's Total Force Fitness and Veterans Affairs' Whole Health approach to care. The Total Force Fitness-Whole Health collaboration is a model of whole-person care for the nation.
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Affiliation(s)
- Cynthia J Gantt
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, 810 Vermont Avenue NW, Room 975, Washington, DC 20571, USA
| | - Nancy Donovan
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, 810 Vermont Avenue NW, Room 975, Washington, DC 20571, USA
| | - Maureen Khung
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, 810 Vermont Avenue NW, Room 975, Washington, DC 20571, USA
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Franzos MA, Stiegmann RA. Partnerships to Facilitate Total Force Fitness. Mil Med 2023; 188:24-27. [PMID: 37665583 DOI: 10.1093/milmed/usad256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/29/2023] [Accepted: 06/30/2023] [Indexed: 09/05/2023] Open
Abstract
Total force fitness (TFF) is a multi-domain framework designed to assess, promote, and sustain human performance optimization across a service member's career arc. During the September 2021, TFF Summit sponsored by the Consortium for Health and Military Performance (CHAMP), a working group explored partnerships that could facilitate effective implementation and sustainment of TFF principles. Many potential partners were identified, both internal and external to the DoD. This report highlights some positions and organizations that provide the highest yield for successfully inculcating TFF across the services.
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Affiliation(s)
- M Alaric Franzos
- Department of Medicine, Uniformed Services University, Bethesda, MD 20814, USA
| | - Regan A Stiegmann
- Tracks and Special Programs, Preventive Medicine and Lifestyle Medicine, Rocky Vista University College of Osteopathic Medicine, Parker, CO 80134, USA
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Howard K, Gantt CJ, Grimsgaard Noyes S, Franzos MA. The Untapped Power of Health and Wellness Coaching. Mil Med 2023; 188:48-52. [PMID: 37665589 DOI: 10.1093/milmed/usad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/01/2023] [Accepted: 03/27/2023] [Indexed: 09/05/2023] Open
Abstract
The Department of Veterans Affairs (VA) has launched an organization-wide transformation to a Whole Health System of Care, which relies heavily on Health and Wellness Coaching. A brief history and overview of Health and Wellness Coaching, in general, is provided, along with specific developments within VA, selected evaluation results, and coordination to date with the Department of Defense. As VA's Whole Health transformation reaches maturity, there is an opportunity to adopt VA's Health and Wellness Coaching approach into the Department of Defense's Total Force Fitness efforts with integration at the unit level.
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Affiliation(s)
- Kelly Howard
- University of Health and Performance, Bentonville, AR 72712, USA
| | - Cynthia J Gantt
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC 20571, USA
| | - Sara Grimsgaard Noyes
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC 20571, USA
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Triscari CA, Rutherford RB, DiMercurio C, Franzos MA. SWOT: Analysis of Strategic Approaches in Total Force Fitness and Whole Health Summit. Mil Med 2023; 188:33-37. [PMID: 37665588 DOI: 10.1093/milmed/usad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/06/2023] [Accepted: 04/21/2023] [Indexed: 09/05/2023] Open
Abstract
Leaders and subject matter experts from the Department of Defense (DoD), Department of Veterans Affairs, and other organizations participated in the Total Force Fitness (TFF) and Whole Health Summit. TFF and Whole Health Summit are holistic programs designed to maximize performance and resilience through interventions across multiple domains of health, wellness, and preparedness. Findings generated from the Summit were collected and categorized using a tool known as a Strengths-Weaknesses-Opportunities-Threats (SWOT) analysis. The SWOT analysis highlighted key beneficial points regarding implementation of TFF-Whole Health principles including (1) a strong history of collaboration between the DoD and Department of Veterans Affairs, (2) a potential boost to recruitment and retention, and (3) better support for military-to-civilian transition. Risks identified ranged from policy limitations to program development within a fiscally constrained environment. The SWOT analysis can focus future efforts.
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Affiliation(s)
- Craig A Triscari
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC 20571, USA
| | - Ronald B Rutherford
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC 20571, USA
| | - Carlo DiMercurio
- Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC 20571, USA
| | - M Alaric Franzos
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Anderson E, Wiener RS, Molloy-Paolillo B, McCullough M, Kim B, Harris JI, Rinne ST, Elwy AR, Bokhour BG. Using a person-centered approach in clinical care for patients with complex chronic conditions: Perspectives from healthcare professionals caring for Veterans with COPD in the U.S. Veterans Health Administration's Whole Health System of Care. PLoS One 2023; 18:e0286326. [PMID: 37352241 PMCID: PMC10289382 DOI: 10.1371/journal.pone.0286326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/13/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The largest nationally integrated health system in the United States, the Veterans Health Administration (VHA), has been undergoing a transformation toward a Whole Health (WH) System of Care. WH Clinical Care, a component of this system, includes holistically assessing the Veteran's life context, identifying what really matters to the Veteran, collaboratively setting and monitoring personal health and well-being goals, and equipping the Veteran with access to conventional and complementary and integrative health resources. Implementation of WH Clinical Care has been challenging. Understanding healthcare professionals' perspectives on the value of and barriers and facilitators to practicing WH Clinical Care holds relevance for not only VHA's efforts but also other health systems, in the U.S. and internationally, that are engaged in person-centered care implementation. OBJECTIVES We sought to understand perspectives of healthcare professionals at VHA on providing WH Clinical Care to Veterans with COPD, as a lens to understand the broader issue of WH Clinical Care for Veterans living with complex chronic conditions. DESIGN We interviewed 25 healthcare professionals across disciplines and services at a VA Medical Center in 2020-2021, including primary care providers, pulmonologists, palliative care providers, and chaplains. Interview transcripts were analyzed using qualitative content analysis. KEY RESULTS Each element of WH Clinical Care raised complex questions and/or concerns, including: (1) the appropriate depth/breadth of inquiry in person-centered assessment; (2) the rationale for elicitation of what really matters; (3) the feasibility and appropriate division of labor in personal health goal setting and planning; and (4) challenges related to referring Veterans to a broad spectrum of supportive services. CONCLUSIONS Efforts to promote person-centered care must account for healthcare professionals' existing comfort with its elements, advocate for a team-based approach, and continue to grapple with the conflicting structural conditions and organizational imperatives.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- The Pulmonary Center and Department of Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States of America
| | - Brianne Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
| | - Megan McCullough
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Public Health, Zuckerberg School of Health Sciences, University of Massachusetts, Lowell, Massachusetts, United States of America
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - J. Irene Harris
- VA Maine Healthcare System, Lewiston, Maine, United States of America
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Seppo T. Rinne
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Division of Pulmonary and Critical Care Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States of America
| | - A. Rani Elwy
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Barbara G. Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
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The Time Is Now for a Whole-Person Health Approach to Public Health. Public Health Rep 2023:333549231154583. [PMID: 36762505 DOI: 10.1177/00333549231154583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Blonigen D, Hyde J, McInnes DK, Yoon J, Byrne T, Ngo T, Smelson D. Integrating data analytics, peer support, and whole health coaching to improve the health outcomes of homeless veterans: Study protocol for an effectiveness-implementation trial. Contemp Clin Trials 2023; 125:107065. [PMID: 36572239 DOI: 10.1016/j.cct.2022.107065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Homelessness is a strong determinant of acute care service utilization (inpatient hospitalization, emergency department visits) among US adults. Data analytics, peer support, and patient-centered approaches can collectively offer high-quality care for homeless patients who frequently utilize acute care ("super utilizers"). However, few outpatient programs have integrated these components and tested their effectiveness for this patient population. OBJECTIVE To test the effectiveness and implementation potential of a novel intervention that integrates data analytics with peers trained in whole health coaching ("Peer Whole Health") to reduce use of acute care among homeless adults. METHODS Using a randomized controlled trial design at two US Veterans Health Administration Medical Centers, we plan to enroll 220 veterans in primary care on VHA's Homeless Registry who are flagged on a super-utilizer clinical dashboard. Participants will complete a baseline interview, be randomized to Enhanced Usual Care (EUC; primary care and data analytics) or EUC plus 18 sessions of Peer Whole Health over 6 months, and be re-interviewed at 3, 6, and 9 months. Qualitative interviews with primary care staff and patients will identify facilitators and barriers to more widespread implementation of the intervention. DISCUSSION The primary hypothesis is that those who receive the intervention will have fewer total days of all-cause hospitalization. If confirmed, the findings can provide healthcare systems that serve homeless super-utilizers with a high-value approach to care that can be integrated into primary care services and reduce overall costs for these patients. CLINICAL TRIAL REGISTRATION The study is registered with ClinicalTrials.gov (NCT05176977).
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Affiliation(s)
- Daniel Blonigen
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Justeen Hyde
- HSR&D Center for Healthcare Organization and Implementation Research, VA Bedford HealthCare System, Bedford, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - D Keith McInnes
- HSR&D Center for Healthcare Organization and Implementation Research, VA Bedford HealthCare System, Bedford, MA, USA; Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Jean Yoon
- HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Thomas Byrne
- HSR&D Center for Healthcare Organization and Implementation Research, VA Bedford HealthCare System, Bedford, MA, USA
| | - Tu Ngo
- VA Bedford HealthCare System, Bedford, MA, USA
| | - David Smelson
- HSR&D Center for Healthcare Organization and Implementation Research, VA Bedford HealthCare System, Bedford, MA, USA; Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Krebs EE, Becker WC, Nelson D, DeRonne BM, Nugent S, Jensen AC, Amundson EC, Manuel JK, Borsari B, Kats AM, Seal KH. Design, methods, and recruitment outcomes of the Veterans' Pain Care Organizational Improvement Comparative Effectiveness (VOICE) study. Contemp Clin Trials 2023; 124:107001. [PMID: 36384218 DOI: 10.1016/j.cct.2022.107001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/29/2022] [Accepted: 11/09/2022] [Indexed: 11/14/2022]
Abstract
The Veterans' Pain Care Organizational Improvement Comparative Effectiveness (VOICE) study is a 12-month pragmatic randomized comparative effectiveness trial conducted at ten United States Veterans Affairs (VA) health care sites. The overall goal was to test interventions to improve pain while reducing opioid use among VA patients with moderate-severe chronic pain despite treatment with long-term opioid therapy (LTOT). Aims were 1) to compare lower-intensity telecare collaborative pain management (TCM) versus higher-intensity integrated pain team management (IPT), and 2) to test the option of switching to buprenorphine (versus no option) in a high-dose subgroup. Recruitment challenges included secular trends in opioid prescribing and the COVID-19 pandemic. Participants were recruited over 3.5 years. Of 6966 potentially eligible patients, 4731 (67.9%) were contacted for telephone eligibility interview; of those contacted, 3398 (71.8%) declined participation, 359 (7.6%) were ineligible, 821 (24.2%) enrolled, and 820 (24.1%) were randomized. The most common reason for declining was satisfaction with pain care (n = 731). The most common reason for ineligibility was not having moderate-severe chronic pain (n = 110). Compared with the potentially eligible population, randomized participants were slightly younger, more often female, had similar prescribed opioids, and had similar or higher rates of pain and mental health diagnoses. The enrolled patient number was lower than the original target, but sufficient to power planned analyses. In conclusion, the VOICE trial enrolled a diverse sample similar to the population of VA patients receiving LTOT. Results will add substantially to limited existing evidence for interventions to improve pain while reducing opioid use. ClinicalTrials.gov identifier: NCT03026790.
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Affiliation(s)
- Erin E Krebs
- Minneapolis VA Health Care System, Minneapolis, MN, United States of America; University of Minnesota Medical School, Minneapolis, MN, United States of America.
| | - William C Becker
- Connecticut VA Health Care System, West Haven, CT, United States of America; Yale University, New Haven, CT, United States of America
| | - David Nelson
- Minneapolis VA Health Care System, Minneapolis, MN, United States of America; University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Beth M DeRonne
- Minneapolis VA Health Care System, Minneapolis, MN, United States of America
| | - Sean Nugent
- Minneapolis VA Health Care System, Minneapolis, MN, United States of America
| | - Agnes C Jensen
- Minneapolis VA Health Care System, Minneapolis, MN, United States of America
| | - Erin C Amundson
- Minneapolis VA Health Care System, Minneapolis, MN, United States of America
| | - Jennifer K Manuel
- San Francisco VA Health Care System, San Francisco, CA, United States of America; University of California, San Francisco, San Francisco, CA, United States of America
| | - Brian Borsari
- San Francisco VA Health Care System, San Francisco, CA, United States of America; University of California, San Francisco, San Francisco, CA, United States of America
| | - Allyson M Kats
- University of Minnesota School of Public Health, Minneapolis, MN, United States of America
| | - Karen H Seal
- San Francisco VA Health Care System, San Francisco, CA, United States of America; University of California, San Francisco, San Francisco, CA, United States of America
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22
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Rich TL, Phelan HL, Gravely AA, Falbo KJ, Finn JA, Matsumoto ME, Muschler KJ, Olney CM, Kiecker JE, Hansen AH. Veteran Perspectives on Phantom Limb Pain and Non-Drug Interventions. J Pain Res 2023; 16:1391-1400. [PMID: 37138954 PMCID: PMC10149775 DOI: 10.2147/jpr.s390658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/13/2023] [Indexed: 05/05/2023] Open
Abstract
Background Phantom limb pain (PLP) commonly occurs post-amputation and can negatively affect the daily functioning of persons with amputation. Best practices for medication and non-drug management remain unclear. Objective To better understand the PLP experience and patients' familiarity with treatments, phone interviews were conducted at the Minneapolis Veterans Affairs Regional Amputation Center in Veterans with amputations. Methods Fifty Veteran participants (average age 66, 96% male) with lower limb amputation were recruited for phone-based data collection of patient-reported outcomes (ie, demographics using the Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R) and pain experience using the Phantom Phenomena Questionnaire) to characterize the population and a semi-structured interview. Notes taken during interviews were analyzed using the Krueger and Casey constant comparison analysis method. Results Participants had an average of 15 years since amputation, and 80% reported PLP as identified with the Phantom Phenomena Questionnaire. Investigators identified several core themes from the qualitative interviews including 1) high variability in the experience of PLP, 2) acceptance and resilience, and 3) PLP treatment perceptions. The majority of participants reported trying common non-drug treatments with none endorsed consistently as highly effective. Conclusion More research is needed to inform identification and implementation of clinical best practices for non-drug interventions for PLP and understand the factors that influence engagement in non-drug interventions. The participants in this study were largely male, so these results may not be generalizable to females.
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Affiliation(s)
- Tonya L Rich
- Minneapolis Veteran’s Affairs Health Care System, Minneapolis, MN, USA
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
- Correspondence: Tonya L Rich, Tel +1 612-467-5463, Fax +1 612-725-2093, Email
| | - Hannah L Phelan
- Minneapolis Veteran’s Affairs Health Care System, Minneapolis, MN, USA
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amy A Gravely
- Minneapolis Veteran’s Affairs Health Care System, Minneapolis, MN, USA
| | - Kierra J Falbo
- Minneapolis Veteran’s Affairs Health Care System, Minneapolis, MN, USA
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
| | - Jacob A Finn
- Minneapolis Veteran’s Affairs Health Care System, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Mary E Matsumoto
- Minneapolis Veteran’s Affairs Health Care System, Minneapolis, MN, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | - Christine M Olney
- Minneapolis Veteran’s Affairs Health Care System, Minneapolis, MN, USA
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
- Department of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Jessica E Kiecker
- Minneapolis Veteran’s Affairs Health Care System, Minneapolis, MN, USA
| | - Andrew H Hansen
- Minneapolis Veteran’s Affairs Health Care System, Minneapolis, MN, USA
- Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
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23
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Serpa JG, Shamblen SR, Atwood K, Sangpukdee A, Whitehead A, Wolf C. Mindfulness-Based Teaching Competency Assessment: Comparing Self-Assessment With Expert Evaluation in the Veterans Administration - Compassionate Awareness Learning Module Program. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2023; 12:27536130231197654. [PMID: 37693682 PMCID: PMC10492467 DOI: 10.1177/27536130231197654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/25/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
Background Meditation, including Mindfulness-Based Interventions (MBI), is a required Complementary and Integrative Health intervention at the US Department of Veterans Affairs (VA). Training VA clinicians to provide MBI at scale must address fidelity concerns and the assessment of clinician competency. Objective The psychometric properties of the Mindfulness-Based Intervention: Teaching Assessment Criteria (MBI:TAC), a widely used tool for assessing facilitator competence, continue to be explored. To support the dissemination of MBI, the utility of using the MBI:TAC for self-assessment for clinicians in a national training program was evaluated. Methods In a training cohort of VA clinicians (n = 39), participant self evaluations on 2 domains of the MBI:TAC are compared to the competency scores of 2 expert evaluators as based on the observations of a 10-minute exercise. Additionally, the inter-rater reliability between the 2 experts was explored. Results Intraclass Correlation for the 2 expert evaluators for Guiding Practice was significant (ρ = .83, P = .003), but was not significant for Embodiment of Mindfulness (ρ = .34, P = .186). Self-evaluation scores were not significantly correlated to expert rater scores such that participants rate their level of competence higher than expert scores. Conclusion The MBI:TAC, while an essential tool in teacher training, may not produce accurate scores when used for self-assessment. Instruction from a senior teacher is needed for accurate scoring. Interrater reliability may be improved with enhanced domain operationalization and training. Implications for MBI training are explored.
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Affiliation(s)
- J Greg Serpa
- Department of Veterans Affairs, Office of Patient Centered Care and Cultural Transformation, Washington, DC, USA
- Department of Veterans Affairs, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | - Kathy Atwood
- Pacific Institute for Research and Evaluation, Louisville, KY, USA
| | - Aree Sangpukdee
- Pacific Institute for Research and Evaluation, Louisville, KY, USA
| | - Alison Whitehead
- Department of Veterans Affairs, Office of Patient Centered Care and Cultural Transformation, Washington, DC, USA
| | - Christiane Wolf
- Department of Veterans Affairs, Office of Patient Centered Care and Cultural Transformation, Washington, DC, USA
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24
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Marchand WR, Zhang C, Hamilton C, Presson AP, Nelson R, Yoo M, Garland EL, Nazarenko E, Herrmann T. Utilization and outcomes of a Whole Health model of care by Veterans with psychiatric illness. Complement Ther Med 2022; 71:102884. [PMID: 36096414 DOI: 10.1016/j.ctim.2022.102884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The Veterans Health Administration (VHA) is implementing a model of healthcare known as Whole Health (WH). The goal of WH is to shift from a disease-oriented system to one that emphasizes health promotion and disease prevention as well as promotes the use of Complementary and Integrative Health. The aim of this project was to investigate utilization and outcomes of WH programming among Veterans with psychiatric disorders. DESIGN This was a retrospective study. Subjects were 7138 Veterans who had a mental health diagnosis. Descriptive data, as well as within- and between-subjects analyses were conducted to investigate utilization and outcomes. SETTING The study was conducted at a large VHA medical center. INTERVENTIONS Whole health interventions considered in this study were mindfulness training, health education, wellbeing, and nutrition classes as well as health coaching. Other whole health interventions, such as acupuncture and message were not evaluated. MAIN OUTCOME MEASURES Utilization of mental health treatment services, medication prescriptions, pain scores and suicide-related behaviors were the primary outcome measures. RESULTS There were 305 Veterans with at least one WH appointment. The existence of several specific psychiatric disorders was associated with WH utilization. The mean number of appointments completed per individual was 6.9 for all WH programming. Finally, WH participation was associated with decreased risk of suicide as well as reduced use of mental health services. There were no significant changes to other outcome variables. CONCLUSIONS WH programming shows promise to reduce suicide risk and the need for mental health services among this population. Additionally, WH services were underutilized and there was a lack of treatment engagement.
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Affiliation(s)
- W R Marchand
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah School of Medicine Department of Psychiatry, 501 Chipeta Way, Salt Lake City, UT 84108, the United States of America; Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, the United States of America.
| | - Chong Zhang
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Clayton Hamilton
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America
| | - Angela P Presson
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Richard Nelson
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Minkyoung Yoo
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Eric L Garland
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah, College of Social Work, 395 S 1500 E, Salt Lake City, UT 84112, the United States of America; University of Utah Center on Mindfulness and Integrative Health Intervention Development, 395 S 1500 E, Salt Lake City, UT 84112, the United States of America
| | - Elena Nazarenko
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America
| | - Tracy Herrmann
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah, Health Sciences Center, Department of Nutrition and Integrative Physiology, Salt Lake City, UT 84108, the United States of America
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25
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Khanna A, Dryden EM, Bolton RE, Wu J, Taylor SL, Clayman ML, Anwar C, Kasom D, McGowan M, Mullur RS, Bokhour BG, Hyde J. Promoting Whole Health and Well-Being at Home: Veteran and Provider Perspectives on the Impact of Tele-Whole Health Services. Glob Adv Health Med 2022; 11:2164957X221142608. [PMID: 36452292 PMCID: PMC9703484 DOI: 10.1177/2164957x221142608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background The Veterans Health Administration (VA) is undergoing a transformation in how healthcare is organized and provided. This transformation to a Whole Health System of Care encompasses the integration of complementary and integrative health services, education, and Whole Health coaching to develop Veterans' self-care skills. During the COVID-19 pandemic, these services were provided via telehealth (tele-WH). Objective We sought to understand Veteran and provider perspectives on how tele-WH impacts Veteran engagement in Whole Health-aligned services and the impact on their well-being. Methods Semi-structured interviews were conducted with 51 providers who delivered tele-WH at 10 VA Medical Centers (VAMCs) and 19 Veterans receiving tele-WH at 6 VAMCs. Participants were asked about their experiences with tele-WH, what they perceived to be the impact of tele-WH on Veterans, and their preferences moving forward. Interviews were transcribed, and a content analysis was performed using a rapid approach. Results We identified 3 major themes that describe the perceived impact of tele-WH on Veterans. These include: (1) increased use of Whole Health-aligned services; (2) deeper engagement with Whole-Health aligned services; and (3) improvements in social, psychological, and physical well-being. Conclusion Tele-WH is perceived to be a strong complement to in-person services and is a promising mechanism for improving engagement with Whole Health-aligned services and promoting Veteran well-being. Future research is needed to measure outcomes identified in this study and to support more equitable access to telehealth for all.
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Affiliation(s)
- Aishwarya Khanna
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Eileen M. Dryden
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Rendelle E. Bolton
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Brandeis University, The Heller School for Social Policy and Management, MA, USA
| | - Juliet Wu
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Stephanie L. Taylor
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
- University of California Los Angeles, David Geffen School of Medicine, Department of Medicine School of Public Health, Department of Health Policy and Management, Los Angeles, CA, USA
| | - Marla L. Clayman
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, 368 Plantation Street Worcester, MA 01605
| | - Chitra Anwar
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Danna Kasom
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
| | - Michael McGowan
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
| | - Rashmi S. Mullur
- US Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy, Los Angeles, CA, USA
- Division of Diabetes, Endocrinology & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Integrative Medicine Collaborative, University of California Los Angeles Health, Los Angeles, CA, USA
| | - Barbara G. Bokhour
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, 368 Plantation Street Worcester, MA 01605
| | - Justeen Hyde
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Boston University School of Medicine, Section of General Internal Medicine, Department of Medicine, Boston, MA, USA
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26
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Anderson E, Dvorin K, Etingen B, Barker AM, Rai Z, Herbst AN, Mozer R, Kingston RP, Bokhour BG. 'It Makes You Sit Back and Think Where You Wanna Go': Veteran experiences in virtual whole health peer-led groups. Health Expect 2022; 25:2548-2556. [PMID: 35957491 PMCID: PMC9615064 DOI: 10.1111/hex.13581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Veterans Health Administration (VHA) is building a Whole Health system of care that aspires to empower and equip each Veteran to pursue a personally meaningful vision of health and well-being. As part of this effort, VHA has developed Taking Charge of My Life and Health (TCMLH), a peer-led, group-based programme that seeks to support Veterans in setting and pursuing health and well-being goals. Prior research showed TCMLH groups to positively impact Veteran outcomes; yet, little is known about Veterans' own experiences and perspectives. METHODS We completed semi-structured telephone interviews with 15 Veterans across 8 sites who had participated in TCMLH groups offered by the VHA in the virtual format between Summer 2020 and Fall 2021. Inductive thematic analysis was applied to interview transcripts to generate themes. FINDINGS We identified five themes regarding Veterans' experiences with TCMLH: (1) navigating the virtual format; (2) internalizing the value of health engagement; (3) making healthy lifestyle changes; (4) forging social connections; and (5) taking on a more active role in healthcare. CONCLUSION Veterans perceived virtual TCMLH groups as meaningful and beneficial, yet also highlighted several challenges. Their perspectives speak to the need to supplement time-limited programmes like TCMLH with ongoing, community-based support. Virtual group-based well-being programmes are a promising innovation. Other healthcare systems may draw on VHA's experience while tailoring format and content to the needs of their patient populations. PATIENT OR PUBLIC CONTRIBUTION Veterans were involved as evaluation participants. A Veteran consultant, who is a coauthor on this paper, was engaged through the conceptualization of the evaluation, development of data collection materials (interview guide) and writing.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
| | - Kelly Dvorin
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH)Edward Hines Jr. VA HospitalHinesIllinoisUSA
| | - Anna M. Barker
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Zenith Rai
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Abigail N. Herbst
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Reagan Mozer
- Department of Mathematical SciencesBentley UniversityWalthamMassachusettsUSA
| | - Rodger P. Kingston
- Veteran Engagement in Research Group, Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
| | - Barbara G. Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR)VA Bedford Healthcare SystemBedfordMassachusettsUSA
- Department of Population and Quantitative Health SciencesUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
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27
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Robinson CH, Thompto AJ, Lima EN, Damschroder LJ. Continuous quality improvement at the frontline: One interdisciplinary clinical team's four-year journey after completing a virtual learning program. Learn Health Syst 2022; 6:e10345. [PMID: 36263266 PMCID: PMC9576248 DOI: 10.1002/lrh2.10345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/07/2022] Open
Abstract
Background The Veterans Health Administration (VHA) is the largest integrated health system in the U.S. and has identified the learning health system as a strategic priority. Clinicians and staff engaging in active learning through continuous quality improvement (QI) is a key pillar for learning system maturity. An interdisciplinary frontline team at a VHA medical center participated in the Learn. Engage. Act. Process. (LEAP) virtual coaching program to learn how to conduct multidisciplinary team-based QI cycles of change. These clinicians lead and deliver the MOVE! weight management program, an evidence-based comprehensive lifestyle intervention. The team worked to continuously improve patient weight loss by engaging in incremental learning cycles of change. The aim of this study is to tell the story of this team's learning experience and the resulting positive reinforcing loop with patient outcomes. Methods This is a mixed methods case study description of one team that participated in the LEAP Program that provides hands-on QI learning for frontline teams with virtual coaching and a structured curriculum. Autoethnographic qualitative descriptions of team experiences over time illustrate this team's continued engagement in learning loops. Multilevel linear modeling was used to assess patient outcomes before vs after the team's participation in LEAP. Results The team's participation in LEAP provided a set of fundamental QI skills and established a commitment to continual learning. Incremental improvements led to significant weight loss for patients who participated in MOVE! after the team completed LEAP (mean = 9.80 pounds; SD 10.43) compared to the pre-LEAP time period (mean = -6.83 pounds; SD 9.63). Conclusions Despite competing priorities and time limitations, this team's experiences provide a positive vision of how team engagement in data-driven continuous learning is feasible at the frontline and can lead to higher job satisfaction and stronger teams. These types of team activities provide much-needed backbone to being a mature learning health system.
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Affiliation(s)
- Claire H. Robinson
- VA Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | | | | | - Laura J. Damschroder
- VA Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborMichiganUSA
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28
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Kligler B, Hyde J, Gantt C, Bokhour B. The Whole Health Transformation at the Veterans Health Administration: Moving From "What's the Matter With You?" to "What Matters to You?". Med Care 2022; 60:387-391. [PMID: 35283434 DOI: 10.1097/mlr.0000000000001706] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Veterans Health Administration is undergoing a system-wide transformation to a Whole Person/Whole Health approach to care. The Whole Health model of care is described including early outcome data on utilization and effectiveness. The paper describes the first 10 years of this transformation and provides lessons learned during that process regarding large-scale system change.
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Affiliation(s)
- Benjamin Kligler
- Office of Patient Centered Care & Cultural Transformation, Veterans Health Administration, Washington, DC
- Department of Family and Community Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System
- Department of General Internal Medicine, Boston University School of Medicine, Boston
| | - Cynthia Gantt
- Office of Patient Centered Care & Cultural Transformation, Veterans Health Administration, Washington, DC
| | - Barbara Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System
- Department of General Internal Medicine, Boston University School of Medicine, Boston
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA
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29
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Kilbourne AM, Garrido MM, Brown A. Translating Research into Policy and Action. Health Serv Res 2022; 57 Suppl 1:5-8. [PMID: 35362119 PMCID: PMC9108221 DOI: 10.1111/1475-6773.13980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Amy M Kilbourne
- Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs.,Department of Learning Health Sciences, University of Michigan
| | - Melissa M Garrido
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System.,Department of Health Law, Policy and Management, Boston University School of Public Health
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research, UCLA School of Medicine.,Olive View-UCLA Medical Center
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