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As of early August 2021, more than 35 million Americans have been infected by COVID-19 and more than 612,300 have died (CDC, COVID Data Tracker), with potential surges ahead as variants continue to emerge. This unprecedented pandemic has led to a significant shift in U.S. healthcare. Like other health systems, VA is primarily focused on the prevention, containment, and treatment of COVID-19. However, the VA healthcare system also must continue to care for Veterans with an array of medical and mental health conditions, which broadens the scope and importance of vaccination among both Veterans and VA healthcare workers.
Evaluating the Vaccine Rollout among Veterans
Several QUERI groups are conducting evaluations related to the COVID-19 pandemic, particularly in regard to the vaccine rollout. The Bridging the Care Continuum for Vulnerable Veterans across VA and Community Care (Bridge) QUERI is evaluating Veterans’ and VA employees’ views on COVID-19 vaccines and their perceptions of VA initiatives to vaccinate Veterans and employees [see feature article]. The Optimizing Function and Independence (Function) QUERI has conducted an evaluation with VA health system employees about COVID-19 vaccine hesitancy. They identified drivers of employees’ decisions to receive COVID-19 vaccine both before and after vaccine availability – and additionally queried VA healthcare providers about their COVID-19 vaccine discussions with VA patients. Function QUERI’s findings suggest targeted COVID-19 vaccine communication strategies to meet the needs of employees who lie along a spectrum of acceptance and represent a range of contexts, including differences by work-related factors and sociodemographic characteristics. And investigators with CARRIAGE (Combating Antimicrobial Resistance through Rapid Implementation of Available Guidelines and Evidence) QUERI are conducting an evaluation to assess Veterans' willingness to receive COVID-19 vaccination and reasons for vaccination or hesitancy. As of May 2021, investigators found that out of 818 Veterans from 28 sites, 60% had received the vaccine and 23% would be in favor of getting a two-dose vaccine, while 17% were not in favor of getting the vaccine. The top three reasons for getting the vaccine were:
- It would be the best way to prevent me from getting COVID-19;
- It is a way that I can contribute to ending the COVID-19 pandemic; and
- So that life can go back to the way it was before the pandemic.
While the top three reasons for not favoring the vaccine were concerns about:
- Future and/or immediate side-effects from the vaccine, and
- How quickly the vaccines were developed.
The respondents' doctor/healthcare provider was by far the most trusted source of information about the COVID-19 vaccine, followed by VA and science experts such as Dr. Anthony Fauci.
Evaluating the Value of Virtual Care Technologies During a Pandemic
In addition to evaluations directly related to the COVID-19 vaccine rollout, QUERI’s eHealth Partnered Evaluation Initiative (Office of Connected Care (OCC) to administer brief web-based surveys to VA care team members who were new users of one of three OCC technologies in 2020: 1) the Annie Automated Texting System; 2) the Patient Viewer mobile health app; and 3) video visits through VA Video Connect (VVC). Follow-up semi-structured interviews were then conducted with a sample of survey respondents who had used either the Annie Texting System or conducted video visits with Veterans to assess challenges they encountered with the technologies, their reasons for adopting the technologies during the COVID-19 pandemic, and their intentions to continue using them post-pandemic. A report describing the survey and interview findings is being developed.
Additional COVID-19 Evaluations from QUERI
The Office of Health Equity (OHE)/QUERI Partnered Evaluation Center (OHE QUERI) is conducting a study on the effects of COVID-19 on racial/ethnic minorities and other vulnerable groups within VA, including groups defined by severe obesity, serious mental illness, mood disorders, and the intersection of race/ethnicity and gender. OHE QUERI uses a population health approach to examine health, healthcare quality, experiences, and outcomes of vulnerable Veteran populations across the VA healthcare system, in part by filling evidence gaps about disparities in understudied vulnerable Veteran populations. This allows for more informed development of equity-focused actions. OHE QUERI’s Principal Investigator, Dr. Donna L. Washington, received the 2020 Under Secretary’s Award for Outstanding Achievement in Health Services Research for a career devoted to addressing the healthcare needs of vulnerable and underserved populations, particularly racial/ethnic minorities and women Veterans. The High-RIsk VETerans (RIVET) QUERI program is examining the implementation and outcomes of the COVID-19 PHI (Preventive Health Initiative) templated note. In March 2021, VA launched the PHI to support primary care in delivering needed services. The template allows the completion of multiple services for a Veteran during a single visit and supports primary care team nurses in completing needed care. The overall goal of RIVET QUERI is to advance the ability of VA primary care to provide comprehensive, evidence-based care for complex, high-risk patients, who are more susceptible to COVID-19. Last but not least, QUERI’s Partnered Evidence-based Policy Resource Center (PEPReC) is working to: evaluate national and county-level excess Veteran mortality and its relationship to COVID-19; develop excess mortality metrics and a database for VA researchers; and assess the impact of COVID-19 on virtual care utilization.