Personalized Health Planning in Primary Care

Personalized Health Planning and Patient-Centered Care in a Primary Care Clinical Setting

VHA_OPCCIn 2014, Center for Research on Personalized Health Care researchers Dr. Leigh Ann Simmons, Connor Drake, and Director Dr. Ralph Snyderman received funding from the Veterans Health Administration’s Office of Patient Centered Care and Cultural Transformation to study the feasibility of incorporating personalized health planning (PHP) into the clinical setting. In partnership with VA clinics in Boston, MA and Bonham, TX, five inpatient and primary care VA clinics in the two different geographic regions customized the personalized health planning process, incorporating the tenets of PHP into their workflow and clinical encounters with patients. Each site also developed a process for patient follow-up and shared goal setting.

Providers and clinical staff reported that a great strength of the PHP process was that it fostered a deeper connection between the patient and their care team, and was helpful in coordinating VHA resources to deliver more comprehensive care. Clinical sites took a major first step towards integrating personalized and patient centered care into a busy clinical workflow by developing a data template to capture patient’s personalized health plans in the electronic health record to streamline process and coordinate care. Results of this work were published in Federal Practitioner in 2016.

Currently, the center is also advising similar projects in collaboration with the Durham VA Medical Center (DURVAMC) and ancillary clinics, including Hillandale Road Clinic I. Our partnership with the DURVAMC was funded by the Office of Patient Centered Care and Cultural Transformation in 2017 to implement a Whole Health Partnership at DURVAMC, developing pathways by which veterans can receive and experience personalized, proactive, patient-centered care. Pathways being implemented at DURVAMC include: Personalized Health Planning in the Primary Care Patient Aligned Care Team, Personalized Health Planning in a Shared Medical Appointment for individuals with pre-diabetes, and Peer-Facilitated Whole Health Groups.

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To learn more about the Department of Veteran’s Affairs approach to personalized health care and patient-centered care, please visit the the VA’s Patient-Centered Care page.