Resnick Adam, Zeliadt Steven B, Ganz David A, Moucheraud Corrina, Chuang Emmeline, Yano Elizabeth M, Taylor Stephanie L
Department of Veterans Affairs, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA.
Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
J Integr Complement Med. 2023 Dec;29(12):805-812. doi: 10.1089/jicm.2022.0816. Epub 2023 Mar 16.
The Department of Veterans Affairs (VA) launched a Whole Health System pilot program in 18 VA "Flagship" medical centers in 2018 in part to expand the provision of complementary and integrative health (CIH) therapies. A longitudinal quasi-experimental design was used to examine Veterans' use of at least 1 of 12 CIH therapies 2 years after initiation of the Flagship pilot program compared with the year before the program started. The sample included Veterans with chronic musculoskeletal pain with at least one visit to a VA primary care, mental health care, or pain clinic in each of the 3 study years. A population-average logit model was used to measure changes in the percentage of Veterans using at least one the CIH therapies over time. Among Veterans with chronic musculoskeletal pain receiving health care at Flagship sites, 9.7% used a CIH therapy before the Flagship program initiation, whereas 14.2% used a therapy in the second year of the program (46.0% increase). In comparison, CIH therapy use among Veterans at non-Flagship sites increased from 10.3% to 12.0% over the same period (16.5% increase). Results from the population-average logit model show that Veterans at Flagship sites were significantly more likely to be CIH therapy users in the first ( < 0.001) and second ( < 0.001) years of the implementation compared with non-Flagship sites. The Flagship pilot program was successful in terms of increasing the use of CIH therapies among Veterans with chronic musculoskeletal pain compared with non-Flagship sites. The Whole Health System implementation that included financial incentives, education, and other support to 18 VA "Flagship" medical centers helped to increase the use of CIH therapies in the VA. Future research should examine which of these efforts were most effective in expanding CIH therapy provision.
退伍军人事务部（VA）于2018年在18家VA“旗舰”医疗中心启动了一项全健康系统试点项目，部分目的是扩大补充和综合健康（CIH）疗法的提供。采用纵向准实验设计，研究旗舰试点项目启动两年后退伍军人对12种CIH疗法中至少一种的使用情况，并与项目开始前一年进行比较。样本包括在3个研究年度中每年至少到VA初级保健、心理健康护理或疼痛诊所就诊一次的慢性肌肉骨骼疼痛退伍军人。使用总体平均对数模型来衡量随着时间推移使用至少一种CIH疗法的退伍军人百分比的变化。在旗舰站点接受医疗保健的慢性肌肉骨骼疼痛退伍军人中，9.7%在旗舰项目启动前使用过CIH疗法，而在项目的第二年，这一比例为14.2%（增加了46.0%）。相比之下，同期非旗舰站点退伍军人中CIH疗法的使用率从10.3%增加到12.0%（增加了16.5%）。总体平均对数模型的结果表明，与非旗舰站点相比，旗舰站点的退伍军人在实施的第一年（<0.001）和第二年（<0.001）使用CIH疗法的可能性显著更高。与非旗舰站点相比，旗舰试点项目在增加慢性肌肉骨骼疼痛退伍军人对CIH疗法的使用方面取得了成功。包括对18家VA“旗舰”医疗中心的经济激励、教育和其他支持在内的全健康系统实施，有助于增加VA中CIH疗法的使用。未来的研究应考察这些努力中哪些在扩大CIH疗法提供方面最有效。
