Abstract

PROJECT SUMMARY Background: VA's Office of Patient-Centered Care and Cultural Transformation's Whole Health (WH) Implementation Guide states: "Whole Health should not be isolated to one specific service line, but instead is the transformation of care in every service line within a VA facility." Yet, the current implementation efforts are focused on primary and mental healthcare service lines. Specialty care plays an important role in the WH System of Care, particularly for Veterans who receive a preponderance of care outside primary care. HIV specialty care is a case in point. Because of the history of HIV, many Veterans with HIV get both specialty and primary care consolidated in their HIV clinics, thus potentially limiting their exposure to WH. Further, a WH approach may be particularly valuable for these Veterans because of their combined challenges of aging, comorbidities and unique social circumstances, including living with a disease intertwined with blame, stigma and marginalization. Thus, HIV specialty care clinics provide an exemplary case to further develop WH implementation guidance for specialty care services. Significance: Implementation guidance on specialty care’s role in the WH System of Care has yet to be fully developed. Primary care-based implementation relies on WH champions, training, leadership support and system strategies to address Veterans’ unique care plans, including coordination across services. Like other specialty care services, the structure of HIV care is vastly different from large, integrated primary care teams. A plan for WH implementation in specialty care settings is thus needed. Innovation & Impact: Implementation plans, co-developed with end users, attend to contextually situated needs and are more likely to be successful. This proposal leverages the expertise of Veterans with HIV, HIV providers and leadership to co-design implementation of WH in HIV specialty care. Co-design is a novel participatory method that goes beyond traditional engagement strategies, like research interviews, by including end users as equal members of the team. We will identify and work with key stakeholders in HIV specialty care (e.g., Veterans, HIV providers and leadership) to co-design a WH implementation blueprint, detailing core implementation features (e.g., the actors in implementation efforts, the actions they take, the targets of their actions, the timing of these actions). Moreover, because the intersection of aging, vulnerability and stigma are emblematic of challenges to caring for many Veteran populations, our blueprint can serve as an exemplar to coordinating a WH approach across VA primary and specialty care settings, truly offering the systems approach envisioned by VA. Specific Aims: We will develop a WH implementation blueprint through the following aims: 1) Understand the extent to which Veterans with HIV are currently receiving WH care at the 18 WH Flagship sites. 2) Examine providers’ and Veterans’ perspectives on WH Clinical Care to learn how they think WH can be implemented in HIV specialty care settings. 3) Working with key stakeholders - Veterans with HIV, HIV providers and leadership - co-design a blueprint for WH implementation in HIV specialty care settings. Methodology: This three-year study uses a mixed-methods design. Aim 1 uses administrative and survey data to quantitatively describe the receipt and use of WH by Veterans with HIV. Aim 2 uses semi-structured, qualitive interviews to explore HIV providers’ and Veterans’ views of WH with attention to strategies that might support or undermine a WH approach to HIV clinical care. Aim 3 uses co-design methods to bring together an expert panel of Veterans and HIV providers, identified in Aims 1 and 2, and leadership. Next Steps/Implementation: Our blueprint will provide the Office of Patient-Centered Care and Cultural Transformation a pragmatic guide to help VA facilities determine how to implement WH in specialty care.

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DRA: Infectious Diseases

DRE: TRL - Applied/Translational

Keywords: Quality of Care

MeSH Terms: None at this time.