1133 — Patient-Centered Care Innovations and Patient Experiences with VA Care

Tarlov E, Edward Hines, Jr. VA Hospital; Jordan N, Edward Hines, Jr. VA Hospital; Burkhart L, Edward Hines, Jr. VA Hospital; Sohn MW, Edward Hines, Jr. VA Hospital; Miskevics SA, Edward Hines, Jr. VA Hospital; LaVela S, Edward Hines, Jr. VA Hospital;

Objectives:
As part of its transformation to a patient-centered healthcare system, in 2010 VA charged selected facilities, Centers of Innovation (COIs), with designing and implementing environment and care innovations to enhance patients' healthcare experiences. We assessed changes in patients' experiences related to shared decision-making communication with providers and perceptions of the quality of their care in 4 COIs and 4 matched comparison facilities (non-COIs) between Fiscal Years (FY) 2009 and 2012.

Methods:
The sample comprised patients receiving care in four geographically dispersed VA medical centers and four comparison facilities, each within the same VA network and with a similar facility complexity rating. Patient experience data came from VA's Survey of Healthcare Experiences of Patients (SHEP), a monthly mail survey of a sample of each facility's patients who received care in the inpatient or outpatient setting in the previous month. For each of seven SHEP items, we pooled surveys from the same quarter and calculated adjusted predicted probabilities of reporting a positive perception in each quarter, FY 2009-2013, using logistic regression with weights to account for the survey structure of the data.

Results:
A total of 13,889 patient SHEP surveys were available for analysis: 6,355 COI and 6,534 non-COI patients. Mean age was 60.8; 60.4% were White and 10.9% were Hispanic. For shared decision making communication, COI patients were increasingly likely and non-COI patients less likely over time to respond usually or always to the question, "In the last 12 months, when there was more than one choice for your treatment or healthcare, did a doctor or other health provider ask which choice was best for you?" (p < 0.007). COI patients' perceptions of VA healthcare overall and that the provider spent enough time with them showed statistically greater improvements compared to non-COI patients (p < 0.007 and p < 0.014, respectively). Other items showed improving trends.

Implications:
Consistent with the literature, Veterans' experiences of their healthcare seem to have improved with implementation of patient-centered care innovations. Given study limitations, results should be interpreted cautiously.

Impacts:
Transformative changes in the healthcare environment have the potential to materially change patient experiences.