P04.19
Purpose: VA is transforming its healthcare system to be personalized, proactive, patient-driven, and focused on holistic patient-centered care (PCC). One strategy is by providing integrative medicine modalities e.g., complementary and alternative medicine (CAM) and integrative mental health (IMH). However, little is known about how referral to/use of these modalities is documented in patients' medical records (EMR). We aim to understand documentation of patient interest in, recommendations to, and participation (or not) in CAM and IMH in EMRs at 4 VAs.
Methods: We utilized administrative data to identify patients with CAM (159) or IMH (534) clinic stop-codes. During FY 2012, 292 CAM and 367 IMH visits were recorded, from which we identified a random sample (∼10 patients each for CAM and IMH) at each VA.
Results: Most CAM-codes were from one VA (88%). IMH use was seen at all 4 VAs, but 92% were from the 3 facilities with sparse CAM-codes. 69 EMR reviews (29 CAM, 40 IMH) are being conducted that include all encounters in the 6 months prior to EMR review date. CAM users were male-83%, white-74%, married-51%, and average age of 63. IMH users were male-81%, white-53%, unmarried-62%, and average age of 50. Findings show variation in consistency/types of documentation for referrals to/use of CAM/IMH. Documentation often uses standardized templates with limited patient-specific/visit-level detail. Patient preferences for CAM/IMH are not regularly documented.
Conclusion: Documentation of the patient's experience is critical to providing PCC. Although EMR templates are helpful for streamlining documentation, richer patient-specific information for use of integrative modalities, e.g., CAM/IMH is needed. Documentation should include patient-reported information, e.g., interest in/experience with, these modalities. Finally, documentation on who CAM/IMH is offered to, who is participating, reason for participating or not, and if providers are following-up on non-use, is needed to understand reach, acceptance, impact, and patient-centeredness of these modalities.
Contact: Jennifer N. Hill, jennifer.hill3@va.gov
