Providing Veteran-centered care is a high priority for the VHA and efforts are underway to improve Veterans' experience through the development of personalized, proactive, and patient-driven care. In addition VA increasingly is focused on providing measurement based care. It is therefore important to be able to systematically measure experiences of care to assess the extent to which current approaches to healthcare delivery are Veteran-centered. The VA currently asks Veterans how satisfied they are with their access to care at the time of their appointment. This project will extend point-of-care assessment to understand a critical aspect of Veterans' experience – provider communication. Assessing Veterans' immediate experience of Veterans at the point-of-care has the potential to provide clinical teams and leadership real-time data to improve Veterans' experiences. We propose to conduct a mixed-methods study of audit-feedback to examine how a brief measure of patient- centered communication, the CollaboRATE, can be used at the point-of care in VA primary care settings. We aim to 1) Assess the feasibility of collecting a brief survey of patient experience of communication with providers at the point-of-care in primary care settings; 2) Describe the variability in collaboRATE scores and proportion of top-scoring patients across providers and clinics; and 3) Assess clinician, clinic leadership, and hospital leadership perspectives on the acceptability and integration of this feedback for guiding patient- centered care quality improvement. We will conduct the study in primary care clinics. Patients will be invited to fill out a brief survey immediately following their primary care appointment. We will calculate response rate to the survey; examine the distribution of scores, the proportion of top-scoring patients by provider and by clinic; examine the association between communication scores and satisfaction with care and self-reported health status. We will present feedback to providers and leaders, including average overall scores benchmarked against other providers and overall score at the clinic level. We will conduct qualitative interviews with providers, clinic leaders, and medical center leaders to understand how they view the value, validity, and practicality of this feedback for improving patient-centered care. Making feedback on patient perceptions of communication available to providers and leadership in real-time may offer an opportunity to conduct quality improvement to improve communication. This is critical to reaching the VA goal of providing personalized, proactive, patient-driven care to all Veterans. The findings will be useful to our operational partners as they seek to measure patient-centered care. It will set the foundation for future studies of the impact of interventions to improve patient-centered care in VHA.

As a learning healthcare system VA must provide measurement-based care to our Veterans. Without adequate measures the VA will not know if they are achieving the goal of high quality care. One critical aspect of high quality is the extent to which VA providers are providing patient-centered care where what matters most to the Veteran drives care planning. This pilot study seeks to assess the potential for a brief, point-of-care survey of Veterans' experience of provider communication to be used as feedback for providers. We will assess feasibility of collecting this measure at the point-of-care, whether the data can meaningfully identify between- provider differences, and how the use of this rapid cycle feedback loop may support improvement of patient- centered communication. We will survey patients about their experiences at the point-of-care, use this to provide structured feedback to providers and leadership, and interview these key stakeholders about their reaction to the feedback and potential impact on patient-centered care.