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

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.

Leveraging Organizational Conditions for Innovation: A Typology of Facility Engagement in the Veterans Health Administration Shark Tank-Style Competition.

Introduction The development and spread of innovation are known challenges in health care. The US Veterans Health Administration (VHA) created a "Shark Tank"-style competition directed at frontline employees. In this annual, systemwide competition, employees submit innovations to the competition, and winning innovations receive support for implementation in other facilities. Method A multiple case study design was used to understand facility engagement in the competition, and the relationship between engagement and organizational conditions. The authors created a typology to describe the relationship between facility engagement in the competition and organizational conditions for innovation. Results Overall, there was high participation in the VHA's competition across all 130 facilities. The authors identified 7 mutually exclusive types of facility engagement. Discussion As expected, facilities with the most established conditions for innovation were the most engaged in the competition. Additionally, other facilities had various ways to be involved. Consequently, there may be benefit to the VHA tailoring how they work with facilities, based on organizational conditions. Larger facilities with ongoing research and more resources may be more suited to develop innovations, whereas smaller facilities could benefit from a focus on adoption. Conclusion These insights are valuable to the VHA and can be used by other health care systems to tailor innovation programs and allocate resources based on diverse needs across a vast health care system.