My Life, My Story

Contemporary healthcare institutions strive to provide humanistic and patient-centered healthcare. To reach this goal, healthcare systems must first look to the patient as a person, before treating a specific malady or pathology. This chapter will illustrate a humanistic approach to the provision of healthcare using the case of the My Life, My Story program in the United States Veterans Health Administration. My Life, My Story is a patient-centered, life story work intervention where learners complete a life story interview with a veteran using standardized prompts from the My Life, My Story protocol. This chapter will describe the My Life My Story program at the VA Boston Healthcare System, the steps and rationale in program development and discussion of impact on the learners, the patients, and humanizing the healthcare system.

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What Do You Want Us to Know?: Learning From Life Stories to Improve Veterans’ Healthcare Experiences

Journal of Patient Experience ◽

10.1177/23743735211069833 ◽

2022 ◽

Vol 9 ◽

pp. 237437352110698

Author(s):

Miriam Rosen ◽

Breanna A. Nguyen ◽

Susheel Khetarpal ◽

Gaetan Sgro

Keyword(s):

Military Service ◽

Life Stories ◽

Life Story ◽

Healthcare Providers ◽

Economic Disadvantage ◽

Veterans Health ◽

Health Administration ◽

Civilian Life ◽

Life Story Interview ◽

Healthcare Experiences

My Life My Story (MLMS) is a national Veterans Health Administration (VA) life story interview program that aims to provide more humanistic care for veterans by focusing on the patient as a person. Our project took place at the Pittsburgh VA Healthcare System and had 3 main goals: (1) describe themes that emerge in MLMS interviews from the prompting question, what do you want your healthcare provider to know about you?; (2) identify topics of importance to veterans and suggest ways for healthcare providers to explore them; and (3) foster a culture at the Pittsburgh VA that places not only the health but also the personal triumphs, hardships, and aspirations of veterans at the center. Veterans provided verbal consent to have their previously recorded stories used in this study. Stories were coded and then analyzed for patterns and themes. A total of 17 veterans participated in our study. Themes that emerged from the stories include (1) Early Hardships; (2) Economic Disadvantage; (3) Polaroid Snapshots; (4) Around the World; (5) Haunted by Combat; (6) Life-altering Moments; (7) Homecoming; (8) Romantic Beginnings & Obstacles; (9) Inequity across Gender & Race; and (10) Facing Mortality. This study's findings underscore the need to address the traumas associated with military service, as well as the challenges faced with re-integration into civilian life, when working with veterans. The MLMS interviews explored in this study can help clinicians identify topics of importance to veterans, strengthen their relationships with their patients, and improve the care that veterans receive.

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Veteran Patient Perspectives and Experiences During Implementation of a Patient-Centered Medical Home Model

Journal of Patient Experience ◽

10.1177/2374373517731602 ◽

2017 ◽

Vol 5 (2) ◽

pp. 107-113 ◽

Cited By ~ 2

Author(s):

Anaïs Tuepker ◽

Summer Newell ◽

Christina Nicolaidis ◽

Marie-Elena Reyes ◽

Maria Carolina González-Prats ◽

...

Keyword(s):

United States ◽

Primary Care ◽

Medical Home ◽

Care Delivery ◽

Hybrid Approach ◽

The United States ◽

Patient Centered Medical Home ◽

Veterans Health ◽

Health Administration ◽

Patient Centered

Background: The Veterans Health Administration (VA) has implemented the largest shift to a patient-centered medical home (PCMH) model of care in the United States to date. Objective: We interviewed veterans about their experiences of primary care to understand whether they observed changes in care during this period as well as to learn which characteristics of care mattered most to their experiences. Method: Qualitative interviews were conducted with 32 veterans receiving primary care at 1 of 8 VA clinics in the northwest United States. Interviews were analyzed using an inductive–deductive hybrid approach by an interdisciplinary team that included a veteran patient. Result: Participants noticed recent positive changes, including improved communications and shorter waits in clinic, but rarely were aware of VA’s PCMH initiative; a strong relationship with the primary care provider and feeling cared for/respected by everyone involved in care delivery were key components of quality care. The needs of the veteran community as a whole also shaped discussion of care expectations. Conclusion: The PCMH model may provide benefits even when invisible to patients. Veteran awareness of population needs suggests a promising role for veteran involvement in further PCMH transformation efforts.

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Legionella in the veterans healthcare system: report of an eight-year survey

Epidemiology and Infection ◽

10.1017/s0950268803001043 ◽

2003 ◽

Vol 131 (2) ◽

pp. 835-839 ◽

Cited By ~ 3

Author(s):

A. A. KELLY ◽

L. H. DANKO ◽

S. M. KRALOVIC ◽

L. A. SIMBARTL ◽

G. A. ROSELLE

Keyword(s):

Healthcare System ◽

Positive Outcome ◽

The United States ◽

Veterans Affairs ◽

Outpatient Clinics ◽

Fiscal Year ◽

Veterans Health ◽

Department Of Veterans Affairs ◽

Health Administration ◽

Healthcare Associated

The Veterans Health Administration (VHA) of the Department of Veterans Affairs tracks legionella disease in the system of 172 medical centres and additional outpatient clinics using an annual census for reporting. In fiscal year 1999, 3·62 million persons were served by the VHA. From fiscal year 1989–1999, multiple intense interventions were carried out to decrease the number of cases and case rates for legionella disease. From fiscal year 1992–1999, the number of community-acquired and healthcare-associated cases decreased in the VHA by 77 and 95·5% respectively (P=0·005 and 0·01). Case rates also decreased significantly for community and healthcare-associated cases (P=0·02 and 0·001, respectively), with the VHA healthcare-associated case rates decreasing at a greater rate than VHA community-acquired case rates (P=0·02). Over the time of the review, the VHA case rates demonstrated a greater decrease compared to the case rates for the United States as a whole (P=0·02). Continued surveillance, centrally defined strategies, and local implementation can have a positive outcome for prevention of disease in a large, decentralized healthcare system.

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Leaning Into Whole Health: Sustaining System Transformation While Supporting Patients and Employees During COVID-19

Global Advances in Health and Medicine ◽

10.1177/21649561211021047 ◽

2021 ◽

Vol 10 ◽

pp. 216495612110210

Author(s):

Eileen M Dryden ◽

Rendelle E Bolton ◽

Barbara G Bokhour ◽

Juliet Wu ◽

Kelly Dvorin ◽

...

Keyword(s):

Healthcare System ◽

Technology Use ◽

Care Delivery ◽

Quality Care ◽

Qualitative Interviews ◽

Veterans Health ◽

Health Administration ◽

System Transformation ◽

Virtual Technology ◽

Exogenous Shock

Background The US Veterans Health Administration (VA) is transforming its healthcare system to create a Whole Health System (WHS) of care. Akin to such reorganization efforts as creating patient-centered medical homes and primary care behavioral health integration, the WHS goes beyond by transforming the entire system to one that takes a proactive approach to support patient and employee health and wellness. The SARS-CoV-2 pandemic disrupted the VA’s healthcare system and added stress for staff and patients, creating an exogenous shock for this transformation towards a WHS. Objective We examined the relationship between VA’s WHS transformation and the pandemic to understand if transformation was sustained during crisis and contributed to VA’s response. Methods Qualitative interviews were conducted as part of a multi-year study of WHS transformation. A single multi-person interview was conducted with 61 WHS leaders at 18 VA Medical Centers, examining WH transformation and use during the pandemic. Data were analyzed using rapid directed content analysis. Results While the pandemic initially slowed transformation efforts, sites intentionally embraced a WH approach to support patients and employees during this crisis. Efforts included conducting patient wellness calls, and, for patients and employees, promoting complementary and integrative health therapies, self-care, and WH concepts to combat stress and support wellbeing. A surge in virtual technology use facilitated innovative delivery of complementary and integrative therapies and promoted continued use of WH activities. Conclusion The pandemic called attention to the need for healthcare systems to address the wellbeing of both patients and providers to sustain high quality care delivery. At a time of crisis, VA sites sustained WH transformation efforts, recognizing WH as one strategy to support patients and employees. This response indicates cultural transformation is taking hold, with WH serving as a promising approach for promoting wellbeing among patients and employees alike.

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Veterans Health Administration’s Whole Health System of Care: Supporting the Health, Well-Being, and Resiliency of Employees

Global Advances in Health and Medicine ◽

10.1177/21649561211022698 ◽

2021 ◽

Vol 10 ◽

pp. 216495612110226

Author(s):

Kavitha P Reddy ◽

Tamara M Schult ◽

Alison M Whitehead ◽

Barbara G Bokhour

Keyword(s):

Health System ◽

Care Delivery ◽

Health Planning ◽

Well Being ◽

Employee Health ◽

Veterans Health ◽

Health Administration ◽

Patient Centered ◽

Foundational Work ◽

Health And Well Being

The Veterans Health Administration (VHA) is implementing a Whole Health System (WHS) of care that empowers and equips Veterans to take charge of their health and well-being and live their lives to the fullest, and increasingly leaders recognize the need and value in implementing a similar approach to support the health and well-being of employees. The purpose of this paper is to do the following: 1) provide an overview of the WHS of care in VHA and applicability in addressing employee resiliency; 2) provide a brief history of employee well-being efforts in VHA to date; 3) share new priorities from VHA leadership as they relate to Employee Whole Health strategy and implementation; and 4) provide a summary of the impacts of WHS of care delivery on employees. The WHS of care utilizes all therapeutic, evidence-based approaches to support self-care goals and personal health planning. Extending these approaches to employees builds upon 10 years of foundational work supporting employee health and well-being in VHA. In 2017, one facility in each of the 18 Veterans Integrated Service Networks (VISNs) in VHA was selected to participate in piloting the WHS of care with subsequent evaluation by VA’s Center for Evaluating Patient-Centered Care (EPCC). Early outcomes, from an employee perspective, suggest involvement in the delivery of the WHS of care and personal use of the whole health approach have a meaningful impact on the well-being of employees and how they experience the workplace. During the COVID-19 pandemic, VHA has continued to support employees through virtual resources to support well-being and resiliency. VHA's shift to this patient-centered model is supporting not only Veteran care but also employee health and well-being at a time when increased support is needed.

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Purchasing Quality Nursing Home Care in the Veterans Health Administration

Innovation in Aging ◽

10.1093/geroni/igaa055 ◽

2020 ◽

Vol 4 (6) ◽

Author(s):

Orna Intrator ◽

Edward Alan Miller ◽

Portia Y Cornell ◽

Cari Levy ◽

Christopher W Halladay ◽

...

Keyword(s):

The United States ◽

Veterans Affairs ◽

Nursing Home Care ◽

Veterans Health ◽

Health Administration ◽

Star Rating ◽

For Profit ◽

Veterans Affairs Medical Centers ◽

And Performance

Abstract Background and Objectives U.S. Department of Veterans Affairs Medical Centers (VAMCs) contract with nursing homes (NHs) in their community to serve Veterans. This study compares the characteristics and performance of Veterans Affairs (VA)-paid and non-VA-paid NHs both nationally and within local VAMC markets. Research Design and Methods VA-paid NHs were identified, characterized, and linked to VAMC markets using data drawn from VA administrative files. NHs in the United States in December 2015 were eligible for the analysis, including. 1,307 VA-paid NHs and 14,253 non-VA-paid NHs with NH Compare measures in 128 VAMC markets with any VA-paid NHs. Measurements were derived from the Centers for Medicare and Medicaid Services (CMS) five-star rating system, NH Compare. Results VA-paid NHs had more beds, residents per day, and were more likely to be for-profit relative to non-VA-paid NHs. Nationally, the average CMS NH Compare star rating was slightly lower among VA-paid NHs than non-VA-paid NHs (3.05 vs. 3.21, p = .04). This difference was seen in all 3 domains: inspection (3.11 vs. 3.23, p < .001), quality (2.68 vs. 2.83, p < .001), and total nurse staffing (3.36 vs. 3.42, p < .10). There was wide variability across VAMC markets in the ratio of average star rating of VA-paid and non-VA-paid NHs (mean ratio = 0.93, interquartile range = 0.78–1.08). Discussion and Implications With increased community NH use expected following the implementation of the MISSION Act, comparison of the quality of purchased services to other available services becomes critical for ensuring quality, including for NH care. Methods presented in this article can be used to examine the quality of purchased care following the MISSION Act implementation. In particular, dashboards such as that for VA-paid NHs that compare to similar non-VA-paid NHs can provide useful information to quality improvement efforts.

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Transformation of the US Veterans Health Administration

Health Economics Policy and Law ◽

10.1017/s1744133105001222 ◽

2006 ◽

Vol 1 (2) ◽

pp. 99-105 ◽

Cited By ~ 12

Author(s):

Jonathan B. Perlin

Keyword(s):

United States ◽

Health Care ◽

Veterans Health Administration ◽

The United States ◽

Veterans Affairs ◽

United States Department ◽

Veterans Health ◽

Department Of Veterans Affairs ◽

Health Administration ◽

The Us

Ten years ago, it would have been hard to imagine the publication of an issue of a scholarly journal dedicated to applying lessons from the transformation of the United States Department of Veterans Affairs Health System to the renewal of other countries' national health systems. Yet, with the recent publication of a dedicated edition of the Canadian journal Healthcare Papers (2005), this actually happened. Veterans Affairs health care also has been similarly lauded this past year in the lay press, being described as ‘the best care anywhere’ in the Washington Monthly, and described as ‘top-notch healthcare’ in US News and World Report's annual health care issue enumerating the ‘Top 100 Hospitals’ in the United States (Longman, 2005; Gearon, 2005).

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Enhancing Regulatory Decision Making for Postmarket Drug Safety

Management Science ◽

10.1287/mnsc.2020.3889 ◽

2021 ◽

Author(s):

Vishal Ahuja ◽

Carlos A. Alvarez ◽

John R. Birge ◽

Chad Syverson

Keyword(s):

Decision Making ◽

Operations Management ◽

The United States ◽

Pharmaceutical Products ◽

Unintended Consequences ◽

Surveillance Systems ◽

Veterans Health ◽

Health Administration ◽

Regulatory Decision ◽

Increased Risk

The U.S. Food and Drug Administration (FDA) regulates the approval and safe public use of pharmaceutical products in the United States. The FDA uses postmarket surveillance systems to monitor drugs already on the market; a drug found to be associated with an increased risk of adverse events (ADEs) is subject to a recall or a warning. A flawed postmarket decision-making process can have unintended consequences for patients, create uncertainty among providers and affect their prescribing practices, and subject the FDA to unfavorable public scrutiny. The FDA’s current pharmacovigilance process suffers from several shortcomings (e.g., a high underreporting rate), often resulting in incorrect or untimely decisions. Thus, there is a need for robust, data-driven approaches to support and enhance regulatory decision making in the context of postmarket pharmacovigilance. We propose such an approach that has several appealing features—it employs large, reliable, and relevant longitudinal databases; it uses methods firmly established in literature; and it addresses selection bias and endogeneity concerns. Our approach can be used to both (i) independently validate existing safety concerns relating to a drug, such as those emanating from existing surveillance systems, and (ii) perform a holistic safety assessment by evaluating a drug’s association with other ADEs to which the users may be susceptible. We illustrate the utility of our approach by applying it retrospectively to a highly publicized FDA black box warning (BBW) for rosiglitazone, a diabetes drug. Using comprehensive data from the Veterans Health Administration on more than 320,000 diabetes patients over an eight-year period, we find that the drug was not associated with the two ADEs that led to the BBW, a conclusion that the FDA evidently reached, as it retracted the warning six years after issuing it. We demonstrate the generalizability of our approach by retroactively evaluating two additional warnings, those related to statins and atenolol, which we found to be valid. This paper was accepted by Vishal Gaur, operations management.

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