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QUERI – Quality Enhancement Research Initiative

QUERI E-news
March 2021

QUERI Highlights Implementation and Evaluation Science
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Spotlight on Evidence-based Policy: Implementing Whole Health in VA

"The EPCC QUERI work on the WholeHealth flagships has created huge implementation momentum for QUERI work, and the work of CIHEC in documenting Veterans' request for and use of CIH approaches that has helped propel the widespread integration of evidence-based CIH across VHA. These are perfect examples of how VA functions as a true learning healthcare system." Benjamin Kligler, MD, MPH Executive Director, OPCC&CT

QUERI’s work on the VA Whole Health initiative is a prime example of successful evidence-based policy. Whole Health (WH) begins with healthcare focusing on Veterans’ goals and priorities combined with traditional, complementary, and integrative healthcare. Since 2012, in partnership with the VA Office of Patient-Centered Care & Cultural Transformation (OPCC-CT), QUERI has supported two centers focused on the implementation and impact of VA’s transformation to a WH system of care (WHS). The Center for Evaluating Patient-Centered Care ( EPCC) has focused on strategies that promote a WHS which empowers and equips Veterans to take charge of their health and wellbeing, and live life to the fullest. EPCC evaluated the impact of the implementation of the WHS on Veterans and employees at 18 WH flagship medical centers.

In 2017, in response to both Veteran and Congressional interest, OPCC-CT and QUERI also funded the Complementary and Integrative Health Evaluation Center ( CIHEC ) to:

  • Evaluate the implementation of evidence-based complementary and integrative health therapies in the WH system of care;
  • Disseminate the evidence for CIH therapies to clinicians, researchers, and other stakeholders.

Impact: The EPCC-CIHEC evaluations found increasing utilization of WH services among Veterans, and a positive association of WH use with many areas of Veterans’ health and well-being. They demonstrated that Veterans with chronic pain who used WH had a three-fold reduction in opioid use and reported better perceptions of the care received as being more patient-centered, greater engagement in healthcare and self-care, and better perceived stress, indicating improvements in overall well-being. Employees with more involvement in the WHS also had lower turnover, lower burnout, and greater motivation.

Policy changes: The work of EPCC and CIHEC formed the foundation for VA’s Congressional report on the impact of implementing the WHS at the 18 flagship sites in response to the Comprehensive Addiction and Recovery Act (CARA). EPCC and CIHEC also supported the response to several other sections of the CARA legislation, including providing data and research to the Congressional Commission on Expediting Veteran Recovery and in support of the development of a plan to expand CIH across VA. In addition, findings from these evaluation centers, in collaboration with OPCC&CT, informed VA leadership’s approval in February 2020 of a VHA national policy (Executive Decision Memo) in support of VHA’s modernization efforts to engage Veterans in Lifelong Health, Well-Being, and Resilience, which mandates the integration of Whole Health into mental health and primary care across VHA.

Future goals of the EPCC-CIHEC evaluation initiatives have been developed in response to  the COVID-19 pandemic, and focus on understanding the deployment of novel telehealth versions of Whole Health (Tele-WH), including facilitators and barriers to delivery of services and the Veteran and provider experience in using these services. EPCC’s evaluation efforts are also informing how WH for employees has helped employees throughout the pandemic response.

Center for Evaluating Patient-Centered Care in VA (EPCC)

Center for Evaluating Patient-Centered Care in VA (EPCC)

Led by Barbara Bokhour

Complementary and Integrative Health Evaluation Center

Complementary and Integrative Health Evaluation Center

Led by Stephanie Taylor

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