Evaluating VA Patient Centered Care: Patient, Provider, and Organizational Views

Edith Nourse Rogers Memorial Veterans Hospital, Bedford MA

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Abstract

Background: Over 40 years ago Balint described patient-centered medicine as "understanding the patient as a unique human being." By the end of the 20th century, patient-centered care (PCC) became a focus of contemporary health care systems. Although the term encompasses multiple foci, most providers, policymakers and researchers agree that PCC represents a shift from traditional, paternalistic, provider-driven, disease-focused approaches towards health care systems that ensure the patient-including his or her attitudes, perceptions, needs, and experiences-is fully integrated into every phase of medical consultation, treatment and follow-up. With the establishment of the Office of Patient-Centered Care and Cultural Transformation (OPCC&CT), VHA has demonstrated its commitment to providing the most patient-centered care possible to our nation's veterans, as an ethical imperative and as a critical element of improving patient care and outcomes. Many of these interventions to improve patient-centered care have are designed based on PCC principles are currently being implemented by the OPCC&CT Centers of Innovation, but how they achieve the goals of PCC remains unknown. Objectives: The goal of this project is to evaluate the experience and practice of PCC at three established OPCC&CT Centers of Innovation (COI), using our team's extensive experience in evaluating patient-centered care, communication, eHealth technologies, integrative therapies and organizational context. The objectives of this evaluation project are: 1) To ascertain the extent to which novel approaches to patient-centered care being implemented in the COIs achieve the goals of PCC. This objective focuses on the "experience" of care from the patient perspective, and the "practice" of care. 2) To analyze the strategies for implementing the PCC initiatives, the provider responses to them, and the organizational factors affecting the initiatives. We will focus our evaluations on four specific aims related to patient-centered care: Aim 1) To examine the extent to which programs and initiatives implemented at the three COIs are meeting their stated objectives and the goals of PCC. Aim 2) To evaluate the effectiveness of available services and innovation initiatives on meeting patient- centered care goals as outlined in our conceptual model. We focus here on two initiatives: health coaching and complementary and integrative therapies. Aim 3) To determine how organizational structures and processes facilitate or hinder the implementation of PCC initiatives and the development of PCC. We will examine this at all levels of the organization at each VHA. Aim 4) To identify how COIs' PCC initiatives utilize eHealth technologies to facilitate patient-centered care. How do sites capitalize on the use of these technologies for HC or PHP? Methods: We propose to complete 5 tasks to address these aims, using a combination of survey, existing VA data sources, qualitative and quantitative methods. We will conduct patient surveys regarding perceptions of care and outcomes, and conduct site visits including qualitative interviews and observation. We will include patients who are participating in or exposed to different innovations and initiatives, staff who are involved in implementing these initiatives and other administrative level key stakeholders. We will utilize existing OPCC&CT data SHEP data and AES and PCMM data to evaluate the impact of the innovations on key provider and patient outcomes.