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Abstract Review

Abstract ID: 3851

Primary Topic: Health Services Research/Cost Effectiveness
Secondary Topic: Integrative medicine delivery models

State of CIH Policy, Use and Delivery in the VA
Ben Kligler, MD, , Washington, DC, United States; Stephanie L. Taylor, PhD, MPH, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States; A. Rani Elwy, PhD, , Boston, MA, United States; Melissa M. Farmer, PhD, MS, VA Greater Los Angeles Healthcare System, North Hills, CA, United States; Karleen Giannitrapani, PhD; Princess Osei-Bonsu, PhD; Katherine Hoggatt, PhD; Steve Zeliadt, PhD; Barbara G. Bokhour, PhD, , Bedford, MA, United States; Uyi Igodan, MPA, VA Greater Los Angeles Healthcare System, North Hills, CA, United States; Michael G. McGowan, MA; Alison M. Whitehead, MPH, , Washington, DC, United States

Late Breaker: No

Overview

The Veterans Health Administration (VHA), the nation’s largest integrated healthcare system, is at the forefront of providing complementary and integrative health (CIH) approaches, with 93% of VHA medical centers providing 2+ CIH approaches in 2015. The Integrative Health Coordinating Center (IHCC) within the VA’s Office of Patient Centered Care and Cultural Transformation formed 2014 to identify and address barriers to providing CIH and to serve as a resource across the VA. Partially in response to the 2016 Comprehensive Recovery and Addiction Act (CARA) legislation, the IHCC is leading a major expansion of CIH provision. Through the VA QUERI Complementary and Integrative Health Evaluation Center (CIHEC), the IHCC and VA health services researchers are collaborating to evaluate the effectiveness and implementation of CIH.

We will review 6 activities and results of this VA IHCC/health service research collaboration.

  1. Overview of IHCC’s efforts - Late 2017, the VA launched the first wave of a national deployment of expanded CIH approaches in a “Whole Health System” effort in 18 VA medical care centers.
  2. “18 in 18” Whole Health Evaluation – We are evaluating the implementation and effectiveness of the Whole Health components, one of which is CIH, at 18 VA medical centers.
  3. CIHEC Environmental Scan of CIH Provision at the VA– In August-September 2017, we conducted a survey of CIH program leaders at all VA medical centers to assess what CIH approaches were available.
  4. CIHEC Veterans CIH Survey – We conducted a survey among a national sample of veterans in July 2017 to learn their use of, satisfaction with, and interest in 24 CIH approaches.
  5. CIHEC PRIMIER – We replicated BraveNet’s longitudinal study of patient reported outcomes (PROs) in two VA sites to examine how CIH approaches are associated with changes in PROs over time.
  6. CIHEC Battlefield Acupucture (BFA)- We examined BFA implementation challenges and strategies. 

Rationale

The VA has been at the forefront of providing CIH approaches to patients. Other healthcare systems and individual providers can learn from our experiences in implementing and evaluating CIH approaches.

Objectives

  1. Learn what CIH policies the VA has developed and activities they are conducting
  2. List the top 3 CIH approaches that Veterans are requesting
  3. List the top CIH approaches being provided and the implementation barriers and strategies used to overcome those barriers
  4. Summarize the Whole Health System model that the VA is adopting
  5. Learn about the policies and resources the VA’s IHCC is providing to individual providers, staff and facilities, as they attempt to implement CIH
  6. Learn about the effectiveness of CIH for a variety of patient health outcomes
  7. Learn about CIH implementation issues

Methods/Session Format

Kligler 2 mins - Introduction

Kliger/Whitehead 15 mins - Overview of IHCC’s efforts

Zeliadt/Taylor 12 mins - “18 in 18” Whole Health Evaluation

Farmer 12 mins - CIHEC Environmental Scan of CIH Provision at the VA

Taylor 12 mins - CIHEC Veterans CIH Survey

Elwy 12 mins - CIHEC PRIMIER

Giannitrapani – CIHEC BFA

Kligler 13 mins - moderated questions from audience

=90 mins total

Outline

  1. We will present what the VA’s IHCC is doing to facilitate the implementation of CIH across the VA system.
  2. We will discuss how we are evaluating the implementation and effectiveness of the CIH portion of the Whole Health program at 18 VA medical centers, using semi-structured interviews, implementation checklists and surveys of patient reported outcomes.
  3. We will present the findings of the CIHEC Environmental Scan online survey of CIH Provision at all VA medical centers.
  4. We will present the findings of the CIHEC Veterans CIH Survey.
  5. Tai chi, yoga, acupuncture and guided imagery all resulted in significant improvements in Veterans’ PROs, especially pain, perceived stress and functioning.
  6. We will review the implementation barrier and strategies used to overcome those barriers.