IMPLEMENTING A WHOLE HEALTH MODEL IN HOME-BASED PRIMARY CARE: STRENGTHS CHALLENGES AND OPPORTUNITIES FOR GROWTH

摘要

The Whole Health model recently adopted by the VA Healthcare System shifts the focus of care from a disease management approach to one that is personalized, proactive, and patient driven. It consists of three essential components: empowering Veterans through partnership with VA providers, equipping Veterans to self-manage and optimize complementary and integrative health (CIH) approaches, and providing clinical care that is integrative, grounded in relationships, and aligned with personal health goals. Adapting whole health strategies to a home-bound, medically complex population of older adults and their caregivers has not yet been described or investigated. In order to fully adopt a Whole Health approach, a VA Home Based Primary Care (HBPC) team (mean patient age 85) conducted a self-evaluation focused on the consistency of its current practices with the Whole Health model. Results of the self-evaluation revealed programmatic strengths and weaknesses in each core area. Flexible scheduling and identification of patient goals build a collaborative partnership driven by Veteran goals and values. Clinical care provided in tandem with CIH approaches occurs in the home, enabling providers to foster a healing environment and relationship. Implementation challenges for Whole Health in HBPC center on accessibility of the full spectrum of CIH, educational and peer support services, and the appropriateness of current materials, such as personalized health plans, for this aging population. The results of this evaluation illuminate the strengths and challenges of implementing Whole Health within HBPC, a first step toward ensuring that every Veteran has access to optimal, whole person care.