Enhancing engagement with health care is the foundation for VHA's transformation to personalized, proactive, patient-driven care that optimizes health and well-being. Patient engagement is linked to better care experiences and better clinical outcomes at reduced costs: the ?triple aim? of healthcare systems. The science devoted to measurement must keep pace with new models of care. The ability to measure Veteran engagement is a critical component of patient-centered care. A self-report measure could be incorporated into patient-facing applications, inform personalized care plans and risk stratification, and facilitate research efforts. Extant measures do not meet VHA needs with respect to literacy levels, measurement sensitivity, or feasibility. Our goal is to develop a Veteran-centered, precise, and predictive patient-report measure that quantifies the propensity to engage with health care. Our approach builds on a Veteran-centered construct definition and item pool derived through extensive pilot work. A multi-level stakeholder engagement strategy will optimize Veteran usability and correspondence with VHA strategic priorities. The use of calibrated item banks will enable flexible implementation for a range of treatment settings and Veteran populations. The proposed aims of this project are to: 1) establish an item bank and corresponding short form that measures a Veteran's propensity to engage with health care; 2) assess concurrent validity and test-retest reliability of the measure; and 3) evaluate the predictive validity of the new measure against objective indicators of patient engagement. The item pool will be evaluated using a national survey of VHA primary care users who have been diagnosed with a mental health condition (depression and PTSD) or chronic medical condition (hypertension and diabetes), oversampling for women and racial minorities. Item Response Theory models will be used to calibrate items. Convergent validity with self-report correlates of patient engagement will provide preliminary validation. Predictive validity will be examined using global and condition-specific indicators of engagement from VA administrative data aggregated over the year following the survey. The VHA population has a high burden of chronic illness. The treatment demands of complex chronic conditions can be overwhelming to patients and account for a disproportionate amount of health care costs. High value care is determined by how well services fit with Veteran needs, preferences, and opportunities to benefit from care. A measure of engagement can help tailor care to Veteran needs and identify individuals who require adjunctive intervention to achieve the most benefit from their care. This research will fill an important gap in population health management, not only by enhancing risk prediction, but by integrating Veteran perspectives through patient-report measures. This work will catalyze efforts to promote engagement with care by providing flexible and practical assessment tools.

Public Health Relevance

Millions of Americans suffer from chronic health conditions. These health conditions are especially common among Veterans served by VHA, where mental health conditions are also extremely common. Health care for these conditions can be complex and time consuming. This study will create a set of brief questions that can help identify individuals who need additional support in order to benefit from their health care services. This will help tailor care to individual needs and improve the health of Veterans served by VHA.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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HSR-2 Determinants of Patient Response to Care (HSR2)
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Veterans Admin Palo Alto Health Care Sys
Palo Alto
United States
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