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28.05.2019 | Original Research | Ausgabe 8/2019

Journal of General Internal Medicine 8/2019

High-Need Patients’ Goals and Goal Progress in a Veterans Affairs Intensive Outpatient Care Program

Zeitschrift:
Journal of General Internal Medicine > Ausgabe 8/2019
Autoren:
BS Kristie Y. Hsu, MPH Cindie Slightam, MD, MS Jonathan G. Shaw, BA Aaron Tierney, DNP, ANP-C Debra L. Hummel, MD, MS Mary K. Goldstein, MD, MSHS Evelyn T. Chang, PhD Derek Boothroyd, MD, MS Donna M. Zulman
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11606-019-05010-w) contains supplementary material, which is available to authorized users.

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Abstract

Background

Healthcare systems nationwide are implementing intensive outpatient care programs to optimize care for high-need patients; however, little is known about these patients’ personal goals and factors associated with goal progress.

Objective

To describe high-need patients’ goals, and to identify factors associated with their goal progress

Design

Retrospective cohort study

Participants

A total of 113 high-need patients participated in a single-site Veterans Affairs intensive outpatient care program.

Main Measures

Two independent reviewers examined patients’ goals recorded in the electronic health record, categorized each goal into one of three domains (medical, behavioral, or social), and determined whether patients attained goal progress during program participation. Logistic regression was used to determine factors associated with goal progress.

Results

The majority (n = 72, 64%) of the 113 patients attained goal progress. Among the 100 (88%) patients with at least one identified goal, 58 set goal(s) in the medical domain; 60 in the behavioral domain; and 52 in the social domain. Within each respective domain, 41 (71%) attained medical goal progress; 34 (57%) attained behavioral goal progress; and 32 (62%) attained social goal progress. Patients with mental health condition(s) (aOR 0.3; 95% CI 0.1–0.9; p = 0.03) and those living alone (aOR 0.4; 95% CI 0.1–1.0; p = 0.05) were less likely to attain goal progress. Those with mental health condition(s) and those who were living alone were least likely to attain goal progress (interaction aOR 0.1 compared to those with neither characteristic; 95% CI 0.0-0.7; p = 0.02).

Conclusions

Among high-need patients participating in an intensive outpatient care program, patient goals were fairly evenly distributed across medical, behavioral, and social domains. Notably, individuals living alone with mental health conditions were least likely to attain progress. Future care coordination interventions might incorporate strategies to address this gap, e.g., broader integration of behavioral and social service components.

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