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Anderson E, Dones M, Cohen-Bearak A, Barker A, Hyde J, Bokhour B. Promoting Health and Wellbeing Through Non-Clinical Arts Programming: Multi-Stakeholder Perspectives From the Veterans Health Administration. Am J Health Promot 2024:8901171241261887. [PMID: 38871354 DOI: 10.1177/08901171241261887] [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: 06/15/2024]
Abstract
PURPOSE While the value of art therapy is well-established and arts are increasingly leveraged to promote health and wellbeing more broadly, little is known about the impacts of non-clinical arts programs. In this preliminary investigation, we sought to fill this gap by exploring diverse stakeholders' perspectives on the impacts of non-clinical arts programming on Veterans receiving care at the Veterans Health Administration (VA). DESIGN Semi-structured qualitative interviews with Veterans, VA staff, and community partners. SETTING Interviewees were recruited from 7 VA medical centers that have recently implemented non-clinical arts programming to promote Veterans' health and wellbeing, some of them in partnership with community organizations. PARTICIPANTS 33 individuals were interviewed, including 9 Veterans, 14 VA staff, and 10 community partners involved in non-clinical arts program implementation. METHOD Interview transcripts were analyzed using iterative rounds of qualitative content analysis. RESULTS The following impacts on Veterans were described: (1) mental health improvements, (2) renewed sense of purpose; (3) increased social connectedness, (4) improved self-esteem, and (5) self-driven engagement in art activities. CONCLUSION Non-clinical arts programming was perceived by diverse stakeholders to offer important benefits for Veterans' health and well-being. Offering non-clinical arts programming inside and outside healthcare facilities' walls is a promising direction for the field of public health undergoing a shift towards holistic approaches to improving individual and population health outcomes.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Makayla Dones
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA
| | - Adena Cohen-Bearak
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA
| | - Anna Barker
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA
| | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Barbara Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Ball DD, Sadler AG, Steffen MJ, Paez MB, Mengeling MA. The impact of patient-provider relationships on choosing between VA and VA-purchased care: A qualitative study of health care decision-making among rural veterans. J Rural Health 2024; 40:430-437. [PMID: 37942663 DOI: 10.1111/jrh.12804] [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: 04/06/2023] [Revised: 08/25/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE Since the Choice Act in 2014, many Veterans have had greater options for seeking Veteran Affairs (VA)-purchased care in the community. We investigated factors that influence rural Veterans' decisions regarding where to seek care. METHODS We utilized semi-structured telephone interviews to query Veterans living in rural or highly rural areas of Midwestern states about their health care options, preferences, and experiences. Interviews were recorded and transcribed, thematically coded, and deductively analyzed using a socioecological approach. FINDINGS Forty rural Veterans (20 men/20 women) ages 28-76 years completed interviews in 2019. We found that rural Veterans often spoke about their relationships and interactions with providers as an important factor in deciding where to seek care. They expressed three socioecological qualities of patient-provider relationships that affected their decisions: (1) personal level-rural Veterans traveled longer distances for more compatible patient-provider relationships; (2) interpersonal level-they sought stable patient-provider relationships that encouraged familiarity, trust, and communication; and (3) organizational level-they emphasized shared identities and expertise that fostered a sense of belonging with their provider. Participants also described how impersonal interactions, status differences, and staff turnover impacted their choice of provider and were disruptive to patient-provider relationships. CONCLUSIONS Rural Veterans' interview responses suggest exploring innovative ways to measure socioecological dimensions (i.e., personal, interpersonal, and organizational) of access-related decisions and patient-provider relationships to better understand health care barriers and needs. Such measures align with the VA's Whole Health approach that emphasizes person-centered care and the value of social relationships to Veterans' health.
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Affiliation(s)
- Daniel D Ball
- Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
| | - Anne G Sadler
- Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Melissa J Steffen
- Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
| | - Monica B Paez
- Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
| | - Michelle A Mengeling
- Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Frank HE, Albanese A, Sun S, Saadeh F, Johnson BT, Elwy AR, Loucks EB. Mindfulness-Based Stress Reduction Health Insurance Coverage: If, How, and When? An Integrated Knowledge Translation (iKT) Delphi Key Informant Analysis. Mindfulness (N Y) 2024; 15:1220-1233. [PMID: 38817538 PMCID: PMC11133142 DOI: 10.1007/s12671-024-02366-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 06/01/2024]
Abstract
Objectives Hundreds of trials have evaluated Mindfulness-Based Stress Reduction (MBSR), but in the United States, it is generally not covered by health insurance. Consequently, the aims were to identify the following: (1) key questions to make decisions about if, how, and when MBSR should be covered by health insurance; (2a) barriers and (2b) facilitators to understand and resolve for MBSR to be covered by health insurance; and (3) highest priority evidence needed to inform health insurance coverage decisions. Methods Key informants (n = 26) included health insurers, healthcare administrators, policymakers, clinicians, MBSR instructors, and MBSR students. An initial pool of items related to the study aims was generated through qualitative interviews. Through the Delphi process, participants rated, discussed, and re-rated each item's relevance. Items were required to reach a consensus of ≥ 80% agreement to be retained for final inclusion. Results Of the original 149 items, 42 (28.2%) met the ≥ 80% agreement criterion and were retained for final inclusion. The most highly rated items informing whether MBSR should be covered by health insurance included research demonstrating that MBSR works and that it is not harmful. The most highly rated barriers to coverage were that MBSR is not a medical treatment and patient barriers to attendance. Highly rated facilitators included the potential of MBSR to address common mental health and psychosomatic problems. Finally, understanding what conditions are effectively treated with MBSR and the impact of MBSR on stress were rated as the highest priority evidence needed to inform health insurance coverage decisions. Conclusions Findings highlight priorities for future research and policy efforts to advance health insurance coverage of MBSR in the United States. Supplementary Information The online version contains supplementary material available at 10.1007/s12671-024-02366-x.
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Affiliation(s)
- Hannah E. Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Ariana Albanese
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Shufang Sun
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI USA
- Mindfulness Center, Brown University, Providence, RI USA
| | - Frances Saadeh
- Mindfulness Center, Brown University, Providence, RI USA
- School of Professional Studies, Brown University, Providence, RI USA
| | - Blair T. Johnson
- Department of Psychological Sciences, University of Connecticut, Storrs, CT USA
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI USA
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA USA
| | - Eric B. Loucks
- Mindfulness Center, Brown University, Providence, RI USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI 02910 USA
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Pless Kaiser A, Daks JS, Korsun L, Heintz H, Moye J, Sloan DM, Cook JM, Vogt D, Spiro A. Enhancing social functioning in older veterans with PTSD: Rationale and design of an intervention and initial RCT. Contemp Clin Trials 2024; 139:107485. [PMID: 38432471 DOI: 10.1016/j.cct.2024.107485] [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: 09/18/2023] [Revised: 02/06/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Older Veterans with Posttraumatic Stress Disorder (PTSD) are often socially isolated and have complex comorbid physical health problems. Aging-related stressors can exacerbate PTSD symptoms. These factors contribute to greater impairment in social functioning and decreased quality of life (QoL). Evidence-based psychotherapies for PTSD often address these issues, but not all older Veterans with PTSD seek help for these challenges, some don't want to engage in trauma-focused treatment, some drop out prematurely, and some still have residual symptoms upon completion. Thus, additional interventions that directly target social functioning among older Veterans with PTSD are needed. METHODS In this paper we describe the development of and feasibility evaluation plan for, "Enhancing Social Functioning for older Veterans with PTSD (ESVP)," a social functioning group intervention for older (>60 years) Veterans with PTSD. This project involved four phases of work: 1) Intervention development, 2) Review of intervention and potential modifications using focus groups, 3) Intervention pilot testing and modification, and 4) A randomized feasibility trial comparing the intervention with a support group control. Intervention modules address interpersonal relationships, effective communication, anger management, social skills, social support/activities, and behavioral activation. CONCLUSION This project details the iterative process used to develop the ESVP intervention designed to enhance social functioning in older Veterans with PTSD, and to evaluate feasibility. Analyses are underway to examine feasibility of conducting ESVP with a sample of older Veterans with PTSD. Findings from the final project phase, the randomized feasibly trial, will inform the design and implementation of a future trial. CLINICALTRIALS gov Identifier: NCT02803125.
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Affiliation(s)
- Anica Pless Kaiser
- National Center for PTSD, Boston, MA, United States of America; VA Boston Healthcare System, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America; New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, United States of America.
| | - Jennifer S Daks
- VA Boston Healthcare System, Boston, MA, United States of America; New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Lynn Korsun
- VA Boston Healthcare System, Boston, MA, United States of America
| | - Hannah Heintz
- VA Boston Healthcare System, Boston, MA, United States of America; New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, United States of America
| | - Jennifer Moye
- VA Boston Healthcare System, Boston, MA, United States of America; New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Denise M Sloan
- National Center for PTSD, Boston, MA, United States of America; VA Boston Healthcare System, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Joan M Cook
- Yale School of Medicine, New Haven, CT, United States of America
| | - Dawne Vogt
- National Center for PTSD, Boston, MA, United States of America; VA Boston Healthcare System, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America
| | - Avron Spiro
- VA Boston Healthcare System, Boston, MA, United States of America; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America; Boston University School of Public Health, Boston, MA, United States of America; Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), United States of America
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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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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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Nicosia FM, Purcell N, Bertenthal D, Usman H, Seidel I, McGrath S, Hildebrand C, McCarthy B, Seal KH. Evaluation of a New Integrative Health and Wellness Clinic for Veterans at the San Francisco VA Health Care System: A Mixed-Methods Pilot Study. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241260034. [PMID: 38867941 PMCID: PMC11168048 DOI: 10.1177/27536130241260034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024]
Abstract
Objective The Integrative Health and Wellness Clinic (IHWC), established in 2019 at the San Francisco VA Health Care System, is an interdisciplinary clinic consisting of a medical provider, dietician, physical therapist, and psychologist trained in complementary and integrative health (CIH) following the VA Whole Health model of care. Veterans with complex chronic conditions seeking CIH and nonpharmacologic approaches are referred to the IHWC. This study evaluated the clinic's acceptability and feasibility among veteran patients and its preliminary impact on health and wellbeing, health-related goals, and use of CIH approaches. Methods Mixed methods were used to assess patient-reported outcomes and experiences with the IHWC. Participants completed surveys administered at baseline and 6-months and a subset completed a qualitative interview. Pre- and post-scores were compared using t-tests and chi-square tests. Results Thirty-five veterans completed baseline and 6-month follow up surveys. Of these, 13% were women; 24% < 50 years of age, and 44% identified as racial/ethnic minorities. Compared to baseline, at 6 months, there were significant (P < .05) improvements in overall health, physical health, perceived stress, and perceived helpfulness of clinicians in assisting with goal attainment; there was a trend toward improved mental health (P = .057). Interviews (n = 25) indicated satisfaction with the interdisciplinary clinical model, support of IHWC providers in goal attainment, and positive impact on physical and mental health. Areas for improvement included logistics related to scheduling of multiple IHWC providers and referrals to other CIH services. Conclusion Results revealed significant improvement in important clinical domains and satisfaction with interprofessional IHWC clinic providers, but also opportunities to improve clinic processes and care coordination. An interdisciplinary clinic focused on CIH and Whole Health is a feasible and acceptable model of care for veterans with complex chronic health conditions in the VA healthcare system.
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Affiliation(s)
- Francesca M Nicosia
- San Francisco VA Healthcare System, San Francisco, CA, USA
- Institute for Health & Aging, University of California, San Francisco, CA, USA
| | - Natalie Purcell
- San Francisco VA Healthcare System, San Francisco, CA, USA
- Departments of Social & Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Dan Bertenthal
- San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Hajra Usman
- San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Ilana Seidel
- San Francisco VA Healthcare System, San Francisco, CA, USA
| | - Sarah McGrath
- San Francisco VA Healthcare System, San Francisco, CA, USA
| | | | | | - Karen H Seal
- San Francisco VA Healthcare System, San Francisco, CA, USA
- Departments of Medicine & Psychiatry, University of California, San Francisco, CA, USA
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Justice C, Sullivan MB, Van Demark CB, Davis CM, Erb M. Guiding Principles for the Practice of Integrative Physical Therapy. Phys Ther 2023; 103:pzad138. [PMID: 37815938 PMCID: PMC10757068 DOI: 10.1093/ptj/pzad138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 07/03/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023]
Abstract
Integrative health is an emerging specialty inside multiple disciplines within the medical community, yet the practice of integrative physical therapy remains undefined. This perspective paper suggests a set of guiding principles to support the role of physical therapy in integrative health. These guiding principles, including therapeutic partnership, whole person health, living systems, movement as an integrative experience, and salutogenesis, are described and explored in-depth as they relate to all aspects of patient care and clinician experience. These guiding principles are articulated within the context of social determinants of health and the interrelated roles that environment, trauma, stress, and lifestyle all play within an integrative physical therapy plan of care. Examples of current integrative physical therapy practices that embody these principles are described. The 5 guiding principles are designed to elicit interprofessional inquiry into how integrative health models can be applied to the art and science of physical therapy practice. The expansion of integrative health into the field of physical therapy has the potential to improve individual and population health, as integrative physical therapy can be used to address prevention, health promotion, primary care, and wellness while acknowledging the complex, dynamic, and interconnected nature of the human condition. IMPACT This perspective article presents 5 guiding principles to establish a framework to define and shape the growing application of an integrative health model to physical therapy practice. These integrative physical therapy guiding principles aim to improve the quality of whole-person, patient-centered care.
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Affiliation(s)
- Catherine Justice
- Integrative Health and Wellness Division of the Department of Medicine, Hennepin Healthcare Systems, Minneapolis, Minnesota, USA
| | - Marlysa B Sullivan
- Empower Veterans Program, Atlanta Veterans Administration Health Care System, Atlanta, Georgia, USA
| | - Cheryl B Van Demark
- Physical Rehabilitation Services, Dignity Health Yavapai Regional Medical Center, Prescott, Arizona, USA
| | - Carol M Davis
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Matt Erb
- The Center for Mind-Body Medicine, Washington District of Columbia, USA
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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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10
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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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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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12
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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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13
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Fischer IC, Nichter B, Aunon FM, Feldman DB, Levy BR, Esterlis I, Pietrzak RH. Suicidal Thoughts and Behaviors in Older U.S. Military Veterans: Results From the National Health and Resilience in Veterans Study. Am J Geriatr Psychiatry 2023; 31:844-852. [PMID: 37211498 PMCID: PMC10731861 DOI: 10.1016/j.jagp.2023.04.013] [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: 01/18/2023] [Revised: 04/10/2023] [Accepted: 04/15/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To identify the prevalence and correlates associated with suicidal thoughts and behaviors (STBs) in a nationally representative sample of older (55+) US military veterans. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (N = 3,356; mean age = 70.6). Self-report measures of past-year suicidal ideation (SI), lifetime suicide plan, lifetime suicide attempt(s), and future suicide intent were examined in relation to sociodemographic, neuropsychiatric, trauma, physical health, and protective factors. RESULTS A total of 6.6% (95% CI = 5.7%-7.8%) of the sample endorsed past-year SI, 4.1% (CI = 3.3%-5.1%) a lifetime suicide plan, 1.8% (CI = 1.4%-2.3%) a lifetime suicide attempt, and 0.9% (CI = 0.5%-1.3%) future suicide intent. Higher levels of loneliness and lower levels of purpose in life were most strongly associated with past-year SI; lifetime history of major depressive disorder with suicide plan and suicide attempt; and frequency of past-year SI and more negative expectations regarding emotional aging with future suicide intent. CONCLUSION These findings provide the most up-to-date nationally representative prevalence estimates of STBs among older military veterans in the United States. Several modifiable vulnerability factors were found to be associated with suicide risk in older US military veterans, suggesting that these factors may be targets for intervention in this population.
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Affiliation(s)
- Ian C Fischer
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder (ICF, IE, RHP), VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine (ICF, BN, FMA, IE, RHP), New Haven, CT.
| | - Brandon Nichter
- Department of Psychiatry, Yale School of Medicine (ICF, BN, FMA, IE, RHP), New Haven, CT
| | - Frances M Aunon
- Department of Psychiatry, Yale School of Medicine (ICF, BN, FMA, IE, RHP), New Haven, CT; VA Connecticut Healthcare System (FMA), West Haven, CT
| | - David B Feldman
- Department of Counseling Psychology, Santa Clara University (DBF), Santa Clara, CA
| | - Becca R Levy
- Department of Social and Behavioral Sciences, Yale School of Public Health (BRL. RHP), New Haven, CT
| | - Irina Esterlis
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder (ICF, IE, RHP), VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine (ICF, BN, FMA, IE, RHP), New Haven, CT
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder (ICF, IE, RHP), VA Connecticut Healthcare System, West Haven, CT; Department of Psychiatry, Yale School of Medicine (ICF, BN, FMA, IE, RHP), New Haven, CT; Department of Social and Behavioral Sciences, Yale School of Public Health (BRL. RHP), New Haven, CT
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14
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Fiscella K, Epstein RM. Why the United States needs a multifaceted definition of health. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad048. [PMID: 38756742 PMCID: PMC10986254 DOI: 10.1093/haschl/qxad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 05/18/2024]
Abstract
How health is conceived and operationalized is an unrecognized contributor to poor health outcomes in the United States. The United States lacks an explicit definition of health, yielding a de facto, implicit biomedical definition in research and in health care that contrasts with how many people define health for themselves. This biomedical conceptualization has led to the development of lifesaving drugs, vaccines, and procedures, but has also resulted in critical underinvestment in people across their lives, beginning in early childhood, in behavioral, environmental, and social determinants. This underinvestment across the entire lifespan in people's health traps the United States in a vicious cycle of chronic disease and unsustainable health care costs. A movement towards holistic definitions of health represents an escape by defining health in more meaningful terms that reflect people's early development, agency, functioning, adaptive capacity, well-being, and lifelong development-that is, the capability for every person to thrive. Adopting and implementing a multifaceted, holistic health definition by federal research and health agencies could transform and humanize health in the United States and advance health equity.
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Affiliation(s)
- Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14620, United States
| | - Ronald M Epstein
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY 14620, United States
- Department of Oncology, University of Rochester School of Medicine and Dentistry,Rochester, NY 14620, United States
- Department of Medicine (Palliative Care), University of Rochester School of Medicine and Dentistry,Rochester, NY 14620, United States
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15
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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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16
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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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17
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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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18
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FISCELLA KEVIN, EPSTEIN RONALDM. The Profound Implications of the Meaning of Health for Health Care and Health Equity. Milbank Q 2023; 101:675-699. [PMID: 37343061 PMCID: PMC10509522 DOI: 10.1111/1468-0009.12660] [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: 03/13/2023] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
Policy Points The meaning of health in health care remains poorly defined, defaulting to a narrow, biomedical disease model. A national dialogue could create a consensus regarding a holistic and humanized definition of health that promotes health care transformation and health equity. Key steps for operationalizing a holistic meaning of health in health care include national leadership by federal agencies, intersectoral collaborations that include diverse communities, organizational and cultural change in medical education, and implementation of high-quality primary care. The 2023 report by the National Academies of Sciences, Engineering, and Medicine on achieving whole health offers recommendations for action.
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19
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Adjognon OL, Cohen-Bearak A, Kaitz J, Bokhour BG, Chatelain L, Charns MP, Mohr DC. Factors affecting the implementation of employee whole health in the veterans health administration: a qualitative evaluation. BMC Health Serv Res 2023; 23:600. [PMID: 37291554 DOI: 10.1186/s12913-023-09450-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 04/26/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND There is increasing recognition of the need to focus on the health and well-being of healthcare employees given high rates of burnout and turnover. Employee wellness programs are effective at addressing these issues; however, participation in these programs is often a challenge and requires large scale organizational transformation. The Veterans Health Administration (VA) has begun to roll out their own employee wellness program-Employee Whole Health (EWH)-focused on the holistic needs of all employees. This evaluation's goal was to use the Lean Enterprise Transformation (LET) model for organizational transformation to identify key factors-facilitators and barriers-affecting the implementation of VA EWH. METHODS This cross-sectional qualitative evaluation based on the action research model reflects on the organizational implementation of EWH. Semi-structured 60-minute phone interviews were conducted in February-April 2021 with 27 key informants (e.g., EWH coordinator, wellness/occupational health staff) knowledgeable about EWH implementation across 10 VA medical centers. Operational partner provided a list of potential participants, eligible because of their involvement in EWH implementation at their site. The interview guide was informed by the LET model. Interviews were recorded and professionally transcribed. Constant comparative review with a combination of a priori coding based on the model and emergent thematic analysis was used to identify themes from transcripts. Matrix analysis and rapid turnaround qualitative methods were used to identify cross-site factors to EWH implementation. RESULTS Eight common factors in the conceptual model were found to facilitate and/or hinder EWH implementation efforts: [1] EWH initiatives, [2] multilevel leadership support, [3] alignment, [4] integration, [5] employee engagement, [6] communication, [7] staffing, and [8] culture. An emergent factor was [9] the impact of the COVID-19 pandemic on EWH implementation. CONCLUSIONS As VA expands its EWH cultural transformation nationwide, evaluation findings can (a) enable existing programs to address known implementation barriers, and (b) inform new sites to capitalize on known facilitators, anticipate and address barriers, and leverage evaluation recommendations through concerted implementation at the organization, process, and employee levels to jump-start their EWH program implementation.
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Affiliation(s)
- Omonyêlé L Adjognon
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Adena Cohen-Bearak
- 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
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Leslie Chatelain
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Martin P Charns
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA.
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20
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Rogers CJ, Elchert CR, Hackney ME. Chiropractic Management of a 67-Year-Old Veteran With Chronic Low Back Pain Utilizing Low-Velocity Flexion-Distraction: A Case Report. J Chiropr Med 2023; 22:157-163. [PMID: 37346235 PMCID: PMC10280086 DOI: 10.1016/j.jcm.2023.03.002] [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: 08/18/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 06/23/2023] Open
Abstract
Objective The purpose of this case report was to describe the treatment of an older veteran with chronic low back pain, utilizing flexion-distraction as a primary intervention for management. Clinical Features A 67-year-old man with chronic low back pain for several decades presented to the chiropractic clinic for evaluation. He reported low back pain that extended into the right lower extremity intermittently. The patient's imaging demonstrated significant degenerative changes in the lumber spinal anatomy. He had never experienced chiropractic interventions or management for his condition. Intervention and Outcome A trial of conservative care with flexion-distraction was applied as a primary intervention for the management of chronic low back pain. Instrument-assisted soft-tissue mobilization and moist heat were also applied for interventions. Despite having no changes in outcome assessments, the patient reported an improvement in his condition, reduced use of pain medication, and increased mobility after 4 sessions over a 4-week period. Conclusion Flexion-distraction was a beneficial chiropractic approach to the management of an older veteran with chronic low back pain and intermittent lower extremity pain for several decades.
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Affiliation(s)
- Casey J. Rogers
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Health Care System, Birmingham, Alabama
- Birmingham VA Medical Center, Birmingham, Alabama
| | | | - Madeleine E. Hackney
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta VA Health Care System, Decatur, Georgia
- Department of Medicine, Division of Geriatrics & Gerontology, Emory University School of Medicine, Atlanta, Georgia
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21
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Tobin J, Zeliadt SB, Upchurch DM, DeFaccio R, Douglas J, Gelman HM, Hawrilenko M, Frochen S, McGinty N, Resnick A, Tomlanovich N, Toyama J, Whitehead AM, Kligler B, Taylor SL. Racial and Ethnic Variation in Complementary and Integrative Health Therapy Use Among US Veterans. JAMA Netw Open 2023; 6:e2318020. [PMID: 37326995 PMCID: PMC10276309 DOI: 10.1001/jamanetworkopen.2023.18020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 04/27/2023] [Indexed: 06/17/2023] Open
Abstract
Importance White individuals are the greatest users of complementary and integrative health (CIH) therapies in the general population, but this might partially be due to differences in age, health condition, and location. Identifying the nuances in racial and ethnic differences in care is one important step to addressing them. Objective To evaluate racial and ethnic differences in Veterans Affairs (VA)-covered CIH therapy use in a more nuanced manner by examining the association of 5 demographic characteristics, health conditions, and medical facility locations with those differences. Design, Setting, and Participants Retrospective cross-sectional observational study of VA health care system users, using electronic health record and administrative data at all VA medical facilities and community-based clinics. Participants included veterans with nonmissing race and ethnicity data using VA-funded health care between October 2018 and September 2019. Data were analyzed from June 2022 to April 2023. Main Outcome and Measure Any use of VA-covered acupuncture, chiropractic care, massage therapy, yoga, or meditation/mindfulness. Results The sample consisted of 5 260 807 veterans with a mean (SD) age of 62.3 (16.4) years and was 91% male (4 788 267 veterans), 67% non-Hispanic White (3 547 140 veterans), 6% Hispanic (328 396 veterans), and 17% Black (903 699 veterans). Chiropractic care was the most used CIH therapy among non-Hispanic White veterans, Hispanic veterans, and veterans of other races and ethnicities, while acupuncture was the most commonly used therapy among Black veterans. When not accounting for the location of the VA medical facilities in which veterans used health care, Black veterans appeared more likely to use yoga and meditation than non-Hispanic White veterans and far less likely to use chiropractic care, while those of Hispanic or other race and ethnicity appeared more likely to use massage than non-Hispanic White veterans. However, those differences mostly disappeared once controlling for medical facility location, with few exceptions-after adjustment Black veterans were less likely than non-Hispanic White veterans to use yoga and more likely to use chiropractic care. Conclusions and Relevance This large-scale, cross-sectional study found racial and ethnic differences in use of 4 of 5 CIH therapies among VA health care system users when not considering their medical facility location. Given those differences mostly disappeared once medical facilities were accounted for, the results demonstrated the importance of considering facilities and residential locations when examining racial differences in CIH therapy use. Medical facilities could be a proxy for the racial and ethnic composition of their patients, CIH therapy availability, regional patient or clinician attitudes, or therapy availability.
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Affiliation(s)
- Jessica Tobin
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California
| | - Steven B. Zeliadt
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
- Department of Health Services, School of Public Health, University of Washington, Seattle
| | - Dawn M. Upchurch
- Department of Community Health Sciences, University of California, Los Angeles Fielding School of Public Health, Los Angeles
| | - Rian DeFaccio
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
| | - Jamie Douglas
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
| | - Hannah M. Gelman
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
| | - Matt Hawrilenko
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
| | - Stephen Frochen
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California
| | - Nathan McGinty
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
| | - Adam Resnick
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California
| | - Nathan Tomlanovich
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, Washington
| | - Joy Toyama
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California
| | - Alison M. Whitehead
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California
| | - Benjamin Kligler
- Office of Patient-Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC
| | - Stephanie L. Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, California
- Department of Medicine, Geffen School of Medicine; University of California, Los Angeles
- Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles
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22
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Krist AH, South-Paul JE, Meisnere M. Achieving Whole Health for Veterans and the Nation: A National Academies of Sciences, Engineering, and Medicine Report. JAMA HEALTH FORUM 2023; 4:e230874. [PMID: 37145685 DOI: 10.1001/jamahealthforum.2023.0874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
This Viewpoint discusses the Whole Health System of care led by the US Department of Veterans Affairs.
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Affiliation(s)
- Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond
- Inova Health System, Fairfax, Virginia
- Wright Regional Center for Clinical and Translational Science, Virginia Commonwealth University, Richmond
| | | | - Marc Meisnere
- National Academies of Sciences, Engineering, and Medicine, Washington, DC
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23
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Cutter CM, Tran LD, Wu S, Urech TH, Seidenfeld J, Kocher KE, Vashi AA. Hospital-level variation in risk-standardized admission rates for emergency care-sensitive conditions among older and younger Veterans. Acad Emerg Med 2023; 30:299-309. [PMID: 36762877 DOI: 10.1111/acem.14691] [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: 09/30/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES Research examining emergency department (ED) admission practices within the Department of Veterans Affairs (VA) is limited. This study investigates facility-level variation in risk-standardized admission rates (RSARs) for emergency care-sensitive conditions (ECSCs) among older (≥65 years) and younger (<65 years) Veterans across VA EDs. METHODS Veterans presenting to a VA ED for an ECSC between October 1, 2016 and September 30, 2019 were identified and the 10 most common ECSCs established. ECSC-specific RSARs were calculated using hierarchical generalized linear models, adjusting for Veteran and encounter characteristics. The interquartile range ratio (IQR ratio) and coefficient of variation were measures of dispersion for each condition and were stratified by age group. Associations with facility characteristics were also examined in condition-specific multivariable models. RESULTS The overall cohort included 651,336 ED visits across 110 VA facilities for the 10 most common ECSCs-chronic obstructive pulmonary disease (COPD), heart failure, pneumonia, volume depletion, tachyarrhythmias, acute diabetes mellitus, gastrointestinal (GI) bleeding, asthma, sepsis, and myocardial infarction (MI). After adjusting for case mix, the ECSCs with the greatest variation (IQR ratio, coefficient of variation) in RSARs were asthma (1.43, 32.12), COPD (1.39, 24.64), volume depletion (1.38, 23.67), and acute diabetes mellitus (1.28, 17.52), whereas those with the least variation were MI (1.01, 0.87) and sepsis (1.02, 2.41). Condition-specific RSARs were not qualitatively different between age subgroups. Association with facility characteristics varied across ECSCs and within condition-specific age subgroups. CONCLUSIONS We identified unexplained facility-level variation in RSARs for Veterans presenting with the 10 most common ECSCs to VA EDs. The magnitude of variation did not appear to be qualitatively different between older and younger Veteran subgroups. Variation in RSARs for ECSCs may be an important target for systems-based levers to improve value in VA emergency care.
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Affiliation(s)
- Christina M Cutter
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Linda D Tran
- Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford Surgery Policy Improvement Research and Education Center, Stanford University, Stanford, California, USA
| | - Siqi Wu
- Stanford Primary Care and Population Health, Stanford University, Stanford, California, USA
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, California, USA
| | - Tracy H Urech
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, California, USA
| | - Justine Seidenfeld
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
| | - Keith E Kocher
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Department of Veterans Affairs Health Services Research & Development, VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Anita A Vashi
- Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Menlo Park, California, USA
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Emergency Medicine (Affiliated), Stanford University, Stanford, California, USA
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24
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Chronic, Noncancer Pain Care in the Veterans Administration. Anesthesiol Clin 2023; 41:519-529. [DOI: 10.1016/j.anclin.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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25
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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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26
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Niles B, Lang A, Olff M. Complementary and integrative interventions for PTSD. Eur J Psychotraumatol 2023; 14:2247888. [PMID: 37655624 PMCID: PMC10478588 DOI: 10.1080/20008066.2023.2247888] [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: 11/15/2022] [Revised: 05/30/2023] [Accepted: 05/30/2023] [Indexed: 09/02/2023] Open
Abstract
ABSTRACTTo treat the impact of trauma, most current evidence supports the use of trauma-focused psychotherapy as the first line approach. However, millions of individuals exposed to trauma worldwide seek Complementary and Integrative Health (CIH) therapies in hopes of achieving wellness above and beyond reducing symptoms. But what is the evidence for CIH interventions? What are potential pitfalls? Given the growing popularity of and strong interest in CIH, EJPT is featuring research on these approaches in this special issue. The papers range from common interventions such as mindfulness to the use of service dogs and scuba diving to alleviate trauma related symptoms. A featured editorial highlights the importance of defining when, where, and how placebo responses work. Nonspecific elements of treatment such as positive expectations, therapeutic rituals, healing symbols, and social interactions are identified as factors influencing treatment response and scientists looking to add to the CIH evidence base are encouraged to consider the impact and methodological challenges these elements present. CIH interventions more specifically recognize and harness some of these factors in addition to intervention-specific factors such as attention or emotion regulation along with focus on overall wellbeing. The body of work in this special issue supports the emerging evidence for meditative and relaxation-based interventions and illustrates a creative but nascent state of the field. Cross-intervention mechanisms that may play a role in achieving wellness, such as arousal reduction, emotion regulation, posttraumatic growth, and positive affect are highlighted. The trauma field would benefit from accumulation of evidence for promising CIH interventions, evaluation of potential mechanisms, and examination of health and wellbeing outcomes. With the paucity of high-quality trials, it would be premature to recommend CIH interventions as first-line treatments. However, the emerging literature on CIH continues to advance our understanding of what works and how these interventions exert their effects.
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Affiliation(s)
- Barbara Niles
- National Center for PTSD, Behavioral Science Division and VA Boston Healthcare System, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Ariel Lang
- VA San Diego Healthcare System and University of California San Diego, San Diego, CA, USA
| | - Miranda Olff
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam Neuroscience, & Amsterdam Public Health, University of Amsterdam, Amsterdam, Netherlands
- ARQ National Psychotrauma Centre, Diemenf, Netherlands
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27
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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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28
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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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