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dc.contributor.authorBokhour, Barbara G
dc.contributor.authorHyde, Justeen
dc.contributor.authorKligler, Benjamin
dc.contributor.authorGelman, Hannah
dc.contributor.authorGaj, Lauren
dc.contributor.authorBarker, Anna M
dc.contributor.authorDouglas, Jamie
dc.contributor.authorDeFaccio, Rian
dc.contributor.authorTaylor, Stephanie L
dc.contributor.authorZeliadt, Steven B
dc.date.accessioned2023-08-10T14:31:41Z
dc.date.available2023-08-10T14:31:41Z
dc.date.issued2022-03-04
dc.identifier.citationBokhour BG, Hyde J, Kligler B, Gelman H, Gaj L, Barker AM, Douglas J, DeFaccio R, Taylor SL, Zeliadt SB. From patient outcomes to system change: Evaluating the impact of VHA's implementation of the Whole Health System of Care. Health Serv Res. 2022 Jun;57 Suppl 1(Suppl 1):53-65. doi: 10.1111/1475-6773.13938. Epub 2022 Mar 4. PMID: 35243621; PMCID: PMC9108226.en_US
dc.identifier.eissn1475-6773
dc.identifier.doi10.1111/1475-6773.13938en_US
dc.identifier.pmid35243621
dc.identifier.urihttp://hdl.handle.net/20.500.14038/52388
dc.description.abstractObjective: To describe how a partnered evaluation of the Whole Health (WH) system of care-comprised of the WH pathway, clinical care, and well-being programs-produced patient outcomes findings, which informed Veterans Health Administration (VA) policy and system change. Data sources: Electronic health records (EHR)-based cohort of 1,368,413 patients and a longitudinal survey of Veterans receiving care at 18 WH pilot medical centers. Study design: In partnership with VA operations, we focused the evaluation on the impact of WH services utilization on Veterans' (1) use of opioids and (2) care experiences, care engagement, and well-being. Outcomes were compared between Veterans who did and did not use WH services identified from the EHR. Data collection: Pharmacy records and WH service data were obtained from the VA EHR, including WH coaching, peer-led groups, personal health planning, and complementary, integrative health therapies. We surveyed veterans at baseline and 6 months to measure patient-reported outcomes. Principal findings: Opioid use decreased 23% (31.5-6.5) to 38% (60.3-14.4) among WH users depending on level of WH use compared to a secular 11% (12.0-9.9) decrease among Veterans using Conventional Care. Compared to Conventional Care users, WH users reported greater improvements in perceptions of care (SMD = 0.138), engagement in health care (SMD = 0.118) and self-care (SMD = 0.1), life meaning and purpose (SMD = 0.152), pain (SMD = 0.025), and perceived stress (SMD = 0.191). Conclusions: Evidence developed through this partnership yielded key VA policy changes to increase Veteran access to WH services. Findings formed the foundation of a congressionally mandated report in response to the Comprehensive Addiction and Recovery Act, highlighting the value of WH and complementary, integrative health and well-being programs for Veterans with pain. Findings subsequently informed issuance of an Executive Decision Memo mandating the integration of WH into mental health and primary care across VA, now one lane of modernization for VA.en_US
dc.language.isoenen_US
dc.relation.ispartofHealth Services Researchen_US
dc.relation.urlhttps://doi.org/10.1111/1475-6773.13938en_US
dc.rightsThis article is a U.S. Government work and is in the public domain in the USA. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.en_US
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.subjectVA health care systemen_US
dc.subjecthealth care organizations and systemsen_US
dc.subjecthealth policy/politics/law/regulationen_US
dc.subjectpatient assessment/satisfactionen_US
dc.subjectevaluation design and researchen_US
dc.titleFrom patient outcomes to system change: Evaluating the impact of VHA's implementation of the Whole Health System of Careen_US
dc.typeJournal Articleen_US
dc.source.journaltitleHealth services research
dc.source.volume57 Suppl 1
dc.source.issueSuppl 1
dc.source.beginpage53
dc.source.endpage65
dc.source.countryUnited States
dc.identifier.journalHealth services research
refterms.dateFOA2023-08-10T14:31:42Z
dc.contributor.departmentPopulation and Quantitative Health Sciencesen_US


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This article is a U.S. Government work and is in the public domain in the USA. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Except where otherwise noted, this item's license is described as This article is a U.S. Government work and is in the public domain in the USA. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.