Conceptualizing the Core Components of Exposure-Informed Care: A Delphi Quality Improvement Study

Area of Science:

• Environmental Health
• Clinical Quality Improvement
• Veterans Affairs Healthcare

Background:

• Environmental exposures are prevalent and can impact health, leading to patient concerns.
• An "informed care" approach, considering patient experiences, is needed to improve clinical care for exposure concerns.
• Understanding Veterans' experiences with military environmental exposures is crucial for effective care.

Purpose of the Study:

• To define the core components of "exposure-informed care" for Veterans.
• To establish a framework for integrating environmental exposure considerations into clinical practice.

Main Methods:

• A modified Delphi quality improvement study was employed.
• Expert opinions from 35 specialists in military environmental exposures were gathered over 4 rounds.
• The Delphi methodology facilitated consensus on key components when evidence is limited.

Main Results:

• Twenty statements were agreed upon as core components of exposure-informed care.
• A 6-part framework was developed, including concordant communication, trust-building, resource provision, assessment, professional responsibility, and integration into care.
• These components represent an expert consensus on defining exposure-informed care.

Conclusions:

• The 6-part framework provides an expert-defined model for "exposure-informed care."
• This framework can guide the implementation of improved care for Veterans facing environmental exposure concerns.
• Further research on the impact and implementation of each component is warranted.