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Exploring the Ripple Effect: Changes in Quality Measures Before and After Whole Health Adoption in Veterans Health
Xiaoyi Zhang1,2, Steven B Zeliadt3,4, Rendelle E Bolton5
1VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA.
Background:
The Veterans Health Administration (VHA) and other health care systems have been moving to patient-centered health care models with a focus on individual goal setting and patient engagement. In VHA, this model of care is called Whole Health, implementation of which began in 2011.
Objective:
To examine whether Whole Health utilization is associated with subsequent improvements in clinical quality measures of chronic disease management and preventive health care services.
Design:
Controlled pre/post quality improvement evaluation accounting for secular trends.
Participants:
Veterans at 125 VHA medical centers who utilized care between 10/01/2022 and 03/31/2023. INTERVENTIONS: Veterans with Whole Health utilization that included Whole Health educational classes, coaching activities, and Whole Health clinical care conversations with providers were assessed alongside reference patients who used general VHA care during the same period. MAIN MEASURES: Change in clinical quality measures one month before using Whole Health care to 6 months after.
Key Results:
The population included 548,968 Whole Health users and 5,428,413 general VHA users. Improvements were observed in all nine clinical quality measures following Whole Health utilization and continued to improve over 6 months. The proportions of Whole Health cohorts with quality improvements were greater than the reference cohorts over the same period. For example, among patients with diabetes, 80.1% of the Whole Health group had good HbA1c control (<8%) at 6 months compared to 74.9% before using Whole Health, an increase of 5.2% (95% CI 4.8-5.6%). The adjusted proportion improving after accounting for demographic and clinical characteristics as well as secular trends in the reference cohort was 4.4% (95% CI 4.1-4.7%).
Conclusions:
These exploratory findings observed that Whole Health utilization was associated with subsequent improvements in health care quality, suggesting this patient-centered care model can potentially augment primary care, achieving a ripple effect improving chronic disease management and preventive care adherence through increased patient activation and engagement.
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