How Veterans Describe Military Environmental Exposure-Informed Care: A Quality Improvement Study

Care for environmental hazards is a particular concern for the Department of Veterans Affairs (VA), which has encouraged "exposure-informed care" (EIC). A recent Delphi study conceptualized 6 core components of EIC (e.g., build trust, assess and document). The current quality improvement project used qualitative interviews with Veterans to understand if and how these core components of EIC are reflected in patient perspectives of their military environmental exposure care at the VA to guide the development of future Veteran-centered tools and education to support the implementation of EIC.

Participants (N = 53) were Veterans who received care at the VA for military environmental exposures. Veterans were interviewed and the team iteratively developed an initial codebook using quotes and supportive statements. The codebook was then applied to the previously established EIC core components and the team identified statements that suggested the presence or absence of EIC.

Findings suggest that when asked broadly about their care for exposure-related conditions, EIC core components are reflected in patient perspectives. The presence and absence of all 6 EIC components were found in Veterans' perspectives of their exposure-related healthcare. Veterans described specific actions from their providers and VA that were important to EIC. Their descriptions suggest the core components work synergistically to impact perceptions of care for military exposures.

The results of this project suggest that future tools to support the implementation of EIC should address EIC core components. Veterans described actions from providers and VA identified as EIC and may be used to design strategies to implement EIC. These strategies should consider incorporating multiple core components into implementation efforts, since Veterans' descriptions suggest the core components synergistically work together to impact care for military exposures.