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.
J Gen Intern Med. 2024 Jan;39(1):84-94. doi: 10.1007/s11606-023-08376-0. Epub 2023 Aug 31.
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.
背景：全人健康（Whole Health，WH）是退伍军人事务部正在实施的一种以患者为中心的护理模式。目前对于 WH 服务的使用如何影响患者的健康和幸福感知之甚少。
目的：我们旨在评估 WH 服务的使用与疼痛和其他患者报告的结果（PRO）在 6 个月内的关联。
设计：一项纵向观察队列评估，比较 WH 用户和常规护理（Conventional Care，CC）用户的 PRO 调查变化。使用逆概率治疗加权（inverse probability of treatment weighting）来平衡两组观察到的人口统计学和临床特征。
参与者：共有 9689 名在 18 个退伍军人事务部医疗中心接受门诊治疗的退伍军人参加了 WH 试点。
干预措施：WH 服务包括设定目标的临床接触、WH 教练、个人健康计划和幸福感服务。
主要结果：主要结果是使用 3 项 PEG 在 6 个月时疼痛强度和干扰的变化。次要结果包括满意度、护理体验、患者参与医疗保健和幸福感。
主要结果：到 6 个月时，有 1053 名退伍军人使用了 WH，3139 名退伍军人仅使用了 CC。WH 用户的基线疼痛 PEG 评分为 6.2（2.5），CC 用户为 6.4（2.3）（差异 p=0.028），分别改善了-2.4%（p=0.006）和-2.3%（p<0.001）。在调整后的分析中，与 CC 相比，WH 使用与 PEG 评分的更大改善无关-1.0%（-2.9%，1.2%）。与 CC 相比，WH 显示出 8 个探索性结果中有 15 个在 6 个月时出现了积极的趋势。WH 使用与 6 个月时退伍军人事务部推荐率增加 2.0%（0.9%，3.3%）相关；目标讨论增加 11.8%（8.2%，15.5%）；对医疗保健互动的看法增加 2.5%（0.4%，4.6%）；健康行为的参与度增加 2.2%（0.3%，3.9%）。
结论：这项研究提供了早期证据，支持提供以 WH 为中心的患者护理服务，以改善退伍军人对护理的体验和参与度。这些是朝着改善退伍军人整体健康和幸福感目标迈出的重要第一步。
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