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Changes in Patient-Reported Outcomes Associated with Receiving Whole Health in the Veteran Health Administration (VHA)’s National Demonstration Project

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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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Data Availability

The datasets generated and analyzed in this study are derived from data in VHA’s Corporate Data Warehouse and a VA operational data set. These data are available to individuals who have authorized approval to access VHA medical record data. Code to replicate the findings can be made available to authorized individuals from the corresponding author.

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Acknowledgements:

The findings presented here were derived from a non-research evaluation in accordance with VHA Handbook 1058.05 and Program Guide 1200.21. The views presented in this paper are those of the authors and do not necessarily represent the position or policy of the Veterans Health Administration or the US Government.

Funding

Funding for the evaluation was provided by the VA Quality Enhancement Research Initiative (PEC 13–001) and the VA Office of Patient-Centered Care and Cultural Transformation.

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Authors and Affiliations

  1. Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA

    Barbara G. Bokhour PhD, Lauren Gaj BA, Anna Barker MS & Christine Deeney BA

  2. Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA

    Barbara G. Bokhour PhD

  3. VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA

    Rian DeFaccio MS, Scott Coggeshall PhD, Hannah Gelman PhD, Eva Thomas MPH & Steven B. Zeliadt PhD

  4. Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Stephanie L. Taylor PhD

  5. Department of Medicine, Department of Health Policy and Management, UCLA, Los Angeles, CA, USA

    Stephanie L. Taylor PhD

  6. Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA

    Steven B. Zeliadt PhD

Authors
  1. Barbara G. Bokhour PhD
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  2. Rian DeFaccio MS
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  10. Steven B. Zeliadt PhD
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Correspondence to Barbara G. Bokhour PhD.

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Bokhour, B.G., DeFaccio, R., Gaj, L. et al. Changes in Patient-Reported Outcomes Associated with Receiving Whole Health in the Veteran Health Administration (VHA)’s National Demonstration Project. J GEN INTERN MED 39, 84–94 (2024). https://doi.org/10.1007/s11606-023-08376-0

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