Complementary and Integrative Health Evaluation Center (CIHEC)

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Project Background: Complementary and integrative health (CIH) such as acupuncture, mindfulness meditation and yoga are emerging as safe, non-pharmacologic options to improve health with few side effects. The VA Evidence Synthesis Program reports the evidence on some CIH as “promising” for certain health conditions that are highly prevalent in Veterans. But the CIH research is almost exclusively on non-Veterans and does not involve patient reported outcomes (PROs). CIH is a national priority for the VA, as it is the focus of a White House request to the VA and a Congressional Act that passed last month, and is specifically included in the 2015 MyVA Integrated Plan, the Blueprint for Excellence, and the Office of Patient Care Services' 2016 PACT Pain Roadmap. Our multi-site qualitative examination of CIH found many reports of unmet Veteran demand for CIH. CIH is reportedly provided in most VHA medical facilities, but usually in very limited capacity due to significant implementation barriers. Project Objectives: In partnership with VHA Office of Patient Centered Care and Cultural Transformation (OPCC&CT), CIHEC's overarching goal is to improve Veterans' health and experiences of care, through increased availability and use of evidence-based CIH. OPCC&CT/CIHEC's specific evaluation goals are to: 1) Improve OPCC&CT's understanding of the details of CIH provision at VHA medical facilities nationally; 2) Improve OPCC&CT's understanding of Veteran preference for and utilization of CIH; 3) Establish procedures for collecting CIH- related PROs in clinical care settings; 4) Examine the effectiveness of CIH on Veterans' health; and 5) Advance implementation science by comparing facilitation strategies across care settings and informing QUERI collaborative efforts to refine facilitation approaches. Project Methods: We propose four projects developed in concert with OPCC&CT. Environmental Scan is a key informant online survey of all CIH service delivery points of contact in the VHA, supplemented with an 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 Veteran demand for and utilization of CIH via the Veteran Insights Panel of 3200 Veterans. Our other two projects are guided by the integrated PARIHS framework and use and test evidence-based facilitation implementation strategies. PRIMIER-I improves the implementation of CIH 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 a hybrid type III implementation study that will a) examine the barriers and facilitators to implementing the VA's National Pain Management Program's auricular acupuncture protocol (BFA); b) examine existing and newly developed implementation strategies among a random sample of low-reach sites to examine implementation outcomes and c) test the effectiveness of BFA by collecting Veterans' PROs. We also will integrate our facilitation strategy findings and collaborate with QUERI Programs and operational partners to disseminate findings and contribute to implementation science on facilitation. Our work is guided by input from the OPCC&CT's national Veteran Advisory Council.