Taylor Stephanie L, Elwy A Rani, Bokhour Barbara G, Coggeshall Scott S, Cohen Amy, Der-Martirosian Claudia, Haderlein Taona, Haun Jolie, Kligler Benjamin, Kloehn Alex T, Lorenz Karl A, Lott Briana, Shin Marlena H, Schult Tammy, Toyama Joy, Whitehead Alison M, Zhang Xiaoyi, Zeliadt Steven B
Center for the Study of Healthcare Innovation, Implementation and Policy, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA.
Department of Medicine and Department of Health Policy and Management, UCLA, Los Angeles, CA, USA.
Glob Adv Integr Med Health. 2024 Apr 6;13:27536130241241259. doi: 10.1177/27536130241241259. eCollection 2024 Jan-Dec.
Assessing the use and effectiveness of complementary and integrative health (CIH) therapies via survey can be complicated given CIH therapies are used in various locations and formats, the dosing required to have an effect is unclear, the potential health and well-being outcomes are many, and describing CIH therapies can be challenging. Few surveys assessing CIH therapy use and effectiveness exist, and none sufficiently reflect these complexities.
In a large-scale Veterans Health Administration (VA) quality improvement effort, we developed the "Complementary and Integrative Health Therapy Patient Experience Survey", a longitudinal, electronic patient self-administered survey to comprehensively assess CIH therapy use and outcomes.
We obtained guidance from the literature, subject matter experts, and Veteran patients who used CIH therapies in designing the survey. As a validity check, we completed cognitive testing and interviews with those patients. We conducted the survey (March 2021-April 2023), inviting 15,608 Veterans with chronic musculoskeletal pain with a recent CIH appointment or referral identified in VA electronic medical records (EMR) to participate. As a second validity check, we compared VA EMR data and patient self-reports of CIH therapy utilization a month after survey initiation and again at survey conclusion.
The 64-item, electronic survey assesses CIH dosing (amount and timing), delivery format and location, provider location, and payor. It also assesses 7 patient-reported outcomes (pain, global mental health, global physical health, depression, quality of life, stress, and meaning/purpose in life), and 3 potential mediators (perceived health competency, healthcare engagement, and self-efficacy for managing diseases). The survey took 17 minutes on average to complete and had a baseline response rate of 45.3%. We found high degrees of concordance between self-reported and EMR data for all therapies except meditation.
Validly assessing patient-reported CIH therapy use and outcomes is complex, but possible.
鉴于补充与整合健康（CIH）疗法的使用地点和形式多种多样，产生疗效所需的剂量尚不明确，潜在的健康和幸福感结果众多，且描述CIH疗法具有挑战性，通过调查评估CIH疗法的使用情况和有效性可能会很复杂。现有的评估CIH疗法使用情况和有效性的调查很少，且没有一项能充分反映这些复杂性。
在退伍军人健康管理局（VA）的一项大规模质量改进工作中，我们开发了“补充与整合健康疗法患者体验调查”，这是一项纵向的、电子的患者自我管理调查，以全面评估CIH疗法的使用情况和结果。
在设计该调查时，我们从文献、主题专家以及使用过CIH疗法的退伍军人患者那里获得了指导。作为有效性检查，我们对这些患者进行了认知测试和访谈。我们开展了该调查（2021年3月至2023年4月），邀请了15608名患有慢性肌肉骨骼疼痛且近期在VA电子病历（EMR）中有CIH预约或转诊记录的退伍军人参与。作为第二项有效性检查，我们在调查开始一个月后以及调查结束时，比较了VA EMR数据和患者关于CIH疗法使用情况的自我报告。
这项64项的电子调查评估了CIH疗法的剂量（数量和时间）、提供形式和地点、提供者地点以及付款人。它还评估了7项患者报告的结果（疼痛、总体心理健康、总体身体健康、抑郁、生活质量、压力以及生活的意义/目的），以及3项潜在的中介因素（感知健康能力、医疗保健参与度以及疾病管理自我效能）。该调查平均需要17分钟完成，基线回复率为45.3%。我们发现，除冥想外，所有疗法的自我报告数据和EMR数据之间都具有高度一致性。
有效评估患者报告的CIH疗法使用情况和结果很复杂，但并非不可能。
