QUERI – Quality Enhancement Research Initiative

Complementary and Integrative Health Evaluation Center

Los Angeles, CA and Boston, MA

Overview

Complementary and integrative health (CIH) approaches such as acupuncture, mindfulness meditation, and yoga are important safe, non-pharmacologic options to improve health with few side effects. The VA Evidence Synthesis Program (ESP) reports the evidence on some CIH as "promising" for certain health conditions highly prevalent among Veterans. Provision of evidence-based CIH approaches is a national priority for the VA and is part of the 2016 Comprehensive Addiction and Recovery Act (CARA). Also, there is evidence of unmet Veteran demand for CIH, which is reportedly provided in most VA medical facilities, but usually in very limited capacity due to significant implementation barriers. As such, the Complementary and Integrative Health Evaluation Center (CIHEC) focuses on examining both the implementation of and evidence for complementary and integrative health approaches.

Objectives

CIHEC's overarching goal is to improve Veterans' health and experiences of care, through increased availability and use of evidence-based CIH approaches. Specific evaluation aims are to:

• Improve our understanding of the details of CIH provision at across all VA medical facilities;
• Advance our understanding of Veterans' preference for and use of CIH;
• Develop procedures for collecting CIH-related patient reported outcomes in clinical care settings;
• Examine the effectiveness of CIH on Veterans' health; and
• Enrich implementation science by comparing facilitation strategies across care settings and informing QUERI collaborative efforts to refine facilitation approaches.

Methodology

CIHEC investigators are conducting four projects:

• Environmental Scan is a key informant online survey of all CIH delivery points of contact within the VA healthcare system. This is supplemented with administrative data extraction to learn details of what, when, where, and by whom CIH is being delivered.
• Veteran Preference for and Utilization of CIH will collect data on Veterans' demand for and use of CIH approaches via the Veteran Insights Panel of 3,200 Veterans.
• PRIMIER-I improves the implementation of CIH-related patient reported outcome (PRO) data collection in usual care settings by developing and evaluating facilitation strategies for changing clinical work flow processes and collecting PROs at the point of care.
• Battlefield Acupuncture (BFA) is an implementation study that will:
  • Examine the barriers and facilitators to implementing VA's National Pain Management Program's auricular acupuncture protocol;
  • Examine existing and newly developed implementation strategies among a random sample of low-reach sites to examine implementation outcomes; and
  • Test the effectiveness of BFA by collecting Veterans' self-reported outcomes.

Operations Partner

The key partner is VA's Office of Patient Centered Care and Cultural Transformation (OPCC&CT). VA recently established the Integrative Health Coordinating Center (IHCC) within OPCC&CT to aid in the development and implementation of CIH approaches in clinical activities, education, and research across the system. As such, OPCC&CT's implementation goals directly address many VA national priorities. The secondary partners for two projects are the VA's Office of Analytics and Business Intelligence (OABI) and VA's National Pain Management Program (NPMP).

Principal Investigator: Stephanie L. Taylor, PhD (LA), contact at Stephanie.Taylor8@va.gov; Co-PI: Steven Zeliadt, PhD, MPH, contact at Steven.Zeliadt@va.gov .