Barker, Abadi, Rao, Harvey, Bokhour
Conference Theme: Innovations in behavioral health services, including telemedicine and technology
Research Objective: Peer-led group programs are increasingly used to deliver optimal care. Moreover, many healthcare systems are focusing resources on health and well-being programs as a way to foster better self-care and prevention. The Veterans Health Administration (VHA) has implemented a 9-week peer-based group program, “Taking Charge of My Life and Health” (TCMLH), where Veterans explore their goals for proactive health and well-being. The course is a component of the VHA’s Whole Health system of care, which empowers and equips Veterans to take charge of their health and well-being, and to live their life to the fullest. We sought to better understand the impact of TCMLH on patient-reported outcomes.
Study Design: We conducted a pre-/post- survey of patient-reported outcomes among Veterans taking the TCMLH course at one VHA hospital. Veterans completed a baseline survey before the first class and again after the last class. The survey included measures to assess patient engagement (Patient Activation Measure) and health-related quality of life (Perceived Stress Scale, Life Engagement Test, PROMIS-10). We obtained means and standard deviations of the scores at the two time points, and used a paired t-test to assess the significance of the differences of the average scores between the two time points.
Population Studied: Veterans at one VA medical center completing the TCMLH course (n=42): 80% male; 69% white non-Hispanic (3% Hispanic and 28% other); and age under 50 (41%), 50-64 (27%) and 65 or over (32%).
Principal Findings: We found improvement in patient-reported outcomes in several key areas. Veterans reported an overall average improvement in quality of life as measured by the PROMIS-10 scale (2.4 (0.9) vs. 2.7 (0.9), p=.01), while mean scores on the Perceived Stress Scale decreased (7.5 (3.3) vs. 6.7 (3.1), p=.05). Veterans also experienced an overall average improvement in patient activation (Patient Activation Measure, 2.9 (0.6) vs. 3.1 (0.6), p=.02), most notably in the areas of proactive communication with providers and in maintaining lifestyle changes. There was improvement in a sense of meaning, aspiration and purpose (Life Engagement Test), including “caring about the things I do” (3.4 (1.2) vs. 3.8 (1.0), p=.05) and “lots of reasons for living” (3.7 (1.2) vs. 4.1 (0.8), p=.01).
Conclusions: Veterans at this VA medical center reported improvement in key areas addressed by the TCMLH course, including both patient engagement and health-related quality of life. The TCMLH group-based peer-led course is a central component of the VHA’s shift to a Whole Health system of care, from providers determining “what is the matter with” a patient, to healthcare teams working in partnership with patients to identify “what matters to” them. Further study is needed to determine clinical outcomes, as well as the extent to which patient-reported outcomes can be sustained longer-term.
Implications for Policy or Practice: A peer-led group-based course that allows patients to explore their healthcare through the lens of goals for proactive health and well-being shows promise as a pathway towards engagement in health.