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Resnick A, Zeliadt SB, Ganz DA, Moucheraud C, Chuang E, Yano EM, Taylor SL. Changes in Use of Complementary and Integrative Health Therapies at the Veterans Affairs: Findings from a Whole Health System Pilot Program. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:805-812. [PMID: 36927089 DOI: 10.1089/jicm.2022.0816] [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: 03/18/2023]
Abstract
Introduction: The Department of Veterans Affairs (VA) launched a Whole Health System pilot program in 18 VA "Flagship" medical centers in 2018 in part to expand the provision of complementary and integrative health (CIH) therapies. Materials and methods: A longitudinal quasi-experimental design was used to examine Veterans' use of at least 1 of 12 CIH therapies 2 years after initiation of the Flagship pilot program compared with the year before the program started. The sample included Veterans with chronic musculoskeletal pain with at least one visit to a VA primary care, mental health care, or pain clinic in each of the 3 study years. A population-average logit model was used to measure changes in the percentage of Veterans using at least one the CIH therapies over time. Results: Among Veterans with chronic musculoskeletal pain receiving health care at Flagship sites, 9.7% used a CIH therapy before the Flagship program initiation, whereas 14.2% used a therapy in the second year of the program (46.0% increase). In comparison, CIH therapy use among Veterans at non-Flagship sites increased from 10.3% to 12.0% over the same period (16.5% increase). Results from the population-average logit model show that Veterans at Flagship sites were significantly more likely to be CIH therapy users in the first (p < 0.001) and second (p < 0.001) years of the implementation compared with non-Flagship sites. Discussion: The Flagship pilot program was successful in terms of increasing the use of CIH therapies among Veterans with chronic musculoskeletal pain compared with non-Flagship sites. Conclusions: The Whole Health System implementation that included financial incentives, education, and other support to 18 VA "Flagship" medical centers helped to increase the use of CIH therapies in the VA. Future research should examine which of these efforts were most effective in expanding CIH therapy provision.
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Affiliation(s)
- Adam Resnick
- Department of Veterans Affairs, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Steven B Zeliadt
- Department of Veterans Affairs, Seattle-Denver Center of Innovation for Veteran Centered and Value Driven Care, Seattle, WA, USA
| | - David A Ganz
- Department of Veterans Affairs, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Corrina Moucheraud
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Emmeline Chuang
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Elizabeth M Yano
- Department of Veterans Affairs, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Stephanie L Taylor
- Department of Veterans Affairs, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Wu J, Bolton RE, Anwar C, Bokhour BG, Khanna A, Mullur RS, Taylor SL, Hyde J. Modifying Whole Health Services for Successful Telehealth Delivery: Lessons from Veterans Health Administration's Rapid Transition During the COVID-19 Pandemic. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:792-804. [PMID: 37668607 DOI: 10.1089/jicm.2023.0106] [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: 09/06/2023]
Abstract
Introduction: The Veterans Health Administration (VHA) is shifting care from a disease-oriented to health-creating approach that aims to provide whole person care. This Whole Health (WH) system combines person-centered care with delivery of WH services (e.g., health coaching, well-being education and skill-building classes, and evidence-based complementary and integrative health therapies), alongside conventional medical services. During the COVID-19 pandemic, WH services were modified for delivery through telehealth (teleWH). This article characterizes modifications to WH services made to maintain continuity during the transition to telehealth formats. Materials and methods: We conducted semistructured qualitative interviews with a purposive sample of 51 providers delivering teleWH services at 10 VHA medical centers. We examined WH service modifications as well as facilitators and barriers to those modifications using rapid coding and directed content analysis. Results: Modifications were driven by (1) preparing for teleWH service delivery and (2) improving teleWH service delivery. To prepare for teleWH services, modifications were prompted by access, readiness, and setting and resources. Modifications to improve the delivery of teleWH services were motivated by engagement, community-building, safety, and content for a teleWH environment. One-on-one teleWH services required the fewest modifications, while more significant modifications were needed for well-being, skill-building, and movement-based groups, and reconfiguration of manual therapies. Discussion: Findings highlighted the need for modifications to ensure that teleWH services are accessible and safe and support interpersonal relationships between patients and providers, as well as in group-based classes. Successfully delivering teleWH services requires proactive preparation that considers access, readiness, and the availability of resources to engage in teleWH services. Tailoring strategies and considering the unique needs of different teleWH services are critical. Conclusions: The COVID-19 pandemic catalyzed teleWH service implementation, utilization, and sustainment. The challenges faced and modifications made during this transition provide lessons learned for other health care systems as they attempt to implement teleWH services.
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Affiliation(s)
- Juliet Wu
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Rendelle E Bolton
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Chitra Anwar
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Barbara G Bokhour
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), 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
| | - Aishwarya Khanna
- U.S. 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, Worcester, MA, USA
| | - Rashmi S Mullur
- U.S. Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy (CSHIIP), Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Department of Medicine, 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
| | - Stephanie L Taylor
- U.S. Department of Veterans Affairs, Center for the Study of Health Care Innovation, Implementation & Policy (CSHIIP), Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Justeen Hyde
- U.S. Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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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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