Medical Care Supplement Features VA/HSR&D Research on Complementary and Integrative Health Therapies within VA

BACKGROUND:
Funded by HSR&D, this special issue of Medical Care highlights how research on complementary and integrative health (CIH) therapies in the VA healthcare system has progressed along the QUERI (Quality Enhancement Research Initiative) Implementation Roadmap – from pre-implementation to implementation to sustainment. For example, researchers are engaging stakeholders during the pre-implementation phase to ensure that evidence-based CIH therapies can be adapted for routine care settings. They also are conducting research to examine the implementation of CIH therapies through the use of selected strategies to ensure their uptake by Veterans, providers, and clinical and operational leaders, as well as sustainment of CIH therapies in usual care, focusing on the business case for VA facilities and building capacity of facility leaders to maintain CIH therapies over time.

Articles in this supplement include, but are not limited to:

• Giannitrapani and colleagues examined providers’ perspectives on the advantages and disadvantages of Battlefield Acupuncture (BFA) in treating Veterans’ pain and found four advantages associated with using BFA, including the perceived utility of BFA for controlling pain and reducing opioid use, as well as building patient-provider trust.
• Zeliadt and colleagues conducted a cohort study of 11,406 Veterans who received BFA at 57 VA medical centers. Their analyses of electronic health records indicated that more than 75% of these Veterans reported immediate pain improvements following BFA, and almost 60% had clinically meaningful reductions in pain intensity.
• In Elwy and colleagues’ practice-based research study, they examined Veterans’ use of CIH therapies as part of routine care over a 12-month period at two VA medical centers and found that Veterans who participated in tai chi, yoga, and meditation reported significant improvements in patient-reported outcomes over time.

Guest Editors for this supplement were A. Rani Elwy, PhD, with HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR), and Stephanie L. Taylor, PhD, who leads QUERI’s Complementary and Integrative Health Evaluation Center and also is an Associate Director at HSR&D’s Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP).

IMPLICATIONS:

• In a Supplement Commentary, Alison Whitehead, MPH, RYT, PMP, with VA’s Integrative Health Coordinating Center, and Benjamin Kligler, MD, MPH, Director of VA’s Office of Patient-Centered Care and Cultural Transformation describe how CIH approaches are becoming more available throughout VA, due to: 1) increased implementation of the Whole Health System of Care, which integrates allopathic and CIH care; and 2) development of the infrastructure for CIH implementation, which includes new standards for hiring CIH providers, the involvement of volunteers who teach CIH, and development of policy and guidance for providing CIH at VAMCs, via telehealth, and/or in the community. Conducting pre-implementation, implementation, and sustainment phases of research on CIH approaches in VA is yet another way to boost the scale-up and spread of these therapies to reach as many Veterans as possible.

The Implementation of Complementary and Integrative Health Therapies in the Veterans Health Administration. Medical Care. September 2020;58(9, Suppl 2).