QUERI – Quality Enhancement Research Initiative

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

Bedford and Boston, MA

Overview:

Most providers, policymakers, and researchers agree that the term 'patient-centered care' (PCC) represents a shift from traditional, provider-driven, disease-focused approaches toward healthcare systems that ensure the patient—including his or her attitudes, perceptions, needs, desires and experiences—is fully integrated into medical consultation, treatment and follow-up. VA's Office of Patient-Centered Care and Cultural Transformation (OPCC&CT) has demonstrated its commitment to providing the most patient-centered care possible to Veterans. Many interventions to improve patient-centered care have been designed based on PCC principles and are currently implemented by the OPCC&CT Centers of Innovation, but how they achieve PCC goals is unknown. Now in its third year, this partnered evaluation initiative, Evaluating Patient-Centered Care at VA (EPCC-VA), evaluates the experience and practice of PCC at VA hospitals throughout the United States.

Project Aims:

The objectives of this continuing project are to:

  • Ascertain the extent to which novel approaches to patient-centered care that are being implemented at VA medical centers achieve the goals of patient-centered care. This objective focuses on the "experience" of care from the patient perspective, and the "practice" of care.
  • Analyze the strategies for implementing the patient-centered care initiatives, the providers' response to them, and the organizational factors affecting the initiatives.

EPCC-VA investigators will focus on four specific aims related to patient-centered care:

1. Examine the extent to which programs and initiatives implemented at VA hospitals are meeting their stated objectives and the goals of PCC.

2. Evaluate the effectiveness of available services and innovation initiatives on meeting PCC goals, with two initiatives being the focus:

  • Implementation of the Whole Health approach, and
  • Implementation, use and effectiveness of complementary and integrative therapies.

3. Determine how organizational structures and processes facilitate or hinder the implementation of PCC initiatives and the development of PCC. This will be examined at all levels of the VA healthcare system.

4. Establish metrics for patient-centered care using patient surveys.

Methodology:

These aims will be accomplished using a combination of surveys, existing VA data sources, as well as qualitative and quantitative methods. Investigators will conduct patient surveys regarding perceptions of care and outcomes, and will conduct site visits including qualitative interviews and observation. They will include patients who are participating in - or are exposed to different innovations and initiatives, and staff who are involved in implementing these initiatives, in addition to other administrative level key stakeholders. They also will utilize existing VA data to evaluate the impact of innovations on key provider and patient outcomes.

Operations Partner: VA's Office of Patient-Centered Care and Cultural Transformation (OPCC&CT), which "works with VA leadership and healthcare providers to transform VA's healthcare system from the traditional medical model, which focuses on treating specific issues, to a personalized, proactive, patient-driven model that promotes whole health for Veterans and their families."

Principal Investigator: Barbara Bokhour, PhD; contact at Barbara.Bokhour@va.gov .