Participating in Complementary and Integrative Health Approaches Is Associated With Veterans' Patient-reported Outcomes Over Time

Author: A Rani Elwy1,2, Stephanie L Taylor3,4, Shibei Zhao1, Michael McGowan3, Dorothy N Plumb1, Wendy Westleigh5, Lauren Gaj1, Grace W Yan6, Barbara G Bokhour1,7
1 VA Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA.
2 Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI.
3 HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health Care System.
4 Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA.
5 Veterans Affairs New Jersey Healthcare System, East Orange.
6 VA National Office of Patient Centered Care & Cultural Transformation, New Jersey VA Health Care System, Lyons, NJ.
7 Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA.
Conference/Journal: Med Care
Date published: 2020 Sep 1
Other: Volume ID: 58 Suppl 2 9S , Pages: S125-S132 , Special Notes: doi: 10.1097/MLR.0000000000001357. , Word Count: 260

Veterans Affairs is dedicated to providing a Whole Health approach to care, including offering complementary and integrative health (CIH) approaches to Veterans.

The objective of this study was to examine the association of CIH participation with Veterans' patient-reported outcomes over time.

Research design:
A survey of patient-reported outcomes at 5 timepoints: baseline, 2, 4, 6, and 12 months.

Veterans participating in any type of CIH approach at 2 Veterans Affairs medical centers.

Mixed hierarchical models with repeated variables were used to test the hypothesis that participating in any CIH approach would be associated with Veterans' overall physical/mental health [Patient-Reported Outcomes Measurement Information System 28 (PROMIS 28)], pain intensity, perceived stress (Perceived Stress Scale-4), and engagement in their care (Patient Activation Measure-13), controlling for age, male sex, site, participation in other CIH approaches, and surveys completed.

We received 401 surveys from 119 Veterans (72% male, age range: 29-85 y) across all timepoints. Yoga participation was related to decreases in perceived stress (P<0.001), while tai chi participation was associated with improvements in overall PROMIS 28 physical and mental health functioning (P<0.02). Specific types of CIH were associated with significant improvements in PROMIS 28 subscales: meditation participation with physical functioning at 2, 6, and 12 months; tai chi participation with anxiety at 2 and 6 months, and ability to participate in social role activities at 2 months. No CIH approach was associated with Veterans' pain or engagement in their care.

As specific CIH approaches are associated with improvements in patient-reported outcomes, clinicians, Veterans, and family members may use this information in discussions of nonpharmacological options to address health and well-being.

PMID: 32826782 DOI: 10.1097/MLR.0000000000001357