Evaluating a Whole Health Approach to Enhance Veteran Care: Exploring the Staff Experience
Abstract: The Whole Health Initiative is a redesign of health care delivery that focuses on administering personalized veteran health plans rather than focusing on treating disease. In 2018, Whole Health launched at 36 Veteran Affairs (VA) facilities throughout the country. Flagship sites (N = 18) implemented the full Whole health system and design sites (N = 18) implemented elements of Whole Health. The project purpose was to identify efforts to improve implementation for this national initiative to improve veterans’ lives. This evaluation project used a cross-sectional design to obtain qualitative semi-structured interview data. Rapid analysis using Consolidated Framework for Implementation Research Constructs (CFIR) was used to identify themes. A snowball sample of 45 staff participants from five design sites and one flagship site participated. Participants represented management and providers among other Whole Health staff. Facilities varied in the degree to which Whole Health was implemented. The provision of leadership support and resources, the need to address national policies and procedures and the need for standardized measures used to measure Whole Health outcomes were common experiences. Implementation of Whole Health to improve veterans’ lives is a complex endeavor. Providers, clinicians, and leadership are engaged and motivated to implement this new delivery model at their facilities, understanding it changes the focus of their relationships with veterans from one of focusing on problems to one of collaboratively working with veterans to achieve individual health goals. Identified barriers limit implementation and expose issues such as lack of facility resources, hiring and training mechanisms, and leadership endorsement. Whole Health is a priority within the VA and the motivation and readiness of VA staff to move into a more collaborative relationship with the veterans they serve are foundational to success and longevity of the program. Our findings created an opportunity to promote sustainable outcomes for future Whole Health implementation efforts.
Abstract: Objectives: Increasing numbers of older adults are reentering community following incarceration (i.e., reentry), yet risk of incident neurodegenerative disorders associated with reentry is unknown. Our objective was to determine association between reentry status (reentry vs never-incarcerated) and mild cognitive impairment (MCI) and/or dementia. Methods: This nationwide, longitudinal cohort study used linked Centers for Medicare & Medicaid Services and Veterans Health Administration data. Participants were aged 65 years or older who experienced reentry between October 1, 2012, and December 31, 2018, with no preincarceration MCI/dementia, compared with age-matched/sex-matched never-incarcerated veterans. MCI/dementia was defined by diagnostic codes. Fine-Gray proportional hazards models were used to examine association. Results: This study included 35,520 veterans, mean age of 70 years, and approximately 1% women. The reentry group (N = 5,920) had higher incidence of MCI/dementia compared with the never-incarcerated group (N = 29,600; 10.2% vs 7.2%; fully adjusted hazard ratio [aHR] 1.12; 95% CI 1.00-1.25). On further investigation, reentry was associated with increased risk of dementia with or without prior MCI diagnosis (aHR 1.21; 95% CI 1.06-1.39) but not MCI only. Discussion: Transition from incarceration to community increased risk of neurocognitive diagnosis. Findings indicate health/social services to identify and address significant cognitive deficits on late-life reentry. Limitations include generalizability to nonveterans.