COVID-19 Preventive Health Inventory: Evaluating a primary care approach to catching-up on needed chronic and preventive care for Veterans

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Background: Chronic disease and preventive care that occurs within primary care was delayed or deferred in the acute COVID-19 crisis, which is expected to have profound impacts on the health of VA patients. In response, the VHA Office of Primary Care (OPC) launched the Preventative Health Initiative (PHI) on March 1st, 2021 to support primary care in delivering needed primary care services. This innovative care coordination intervention leverages three main components: 1) development of an electronic dashboard utilizing 10 common chronic and preventive care quality measures; 2) using nurse care managers for proactive virtual care visits; and 3) the use of structured electronic health record note template to complete needed care. Our current work has shown substantial PHI use and diffusion; however, little is known about implementation and outcomes from PHI uptake. Our proposal will address these knowledge gaps and provide needed evidence on mitigation strategies being supported by the OPC. Significance/Impact: This study will build on ongoing collaborations between VA’s OPC and health services researchers and provide needed evidence that the VA health system can use to better serve Veterans in ongoing pandemic response and recovery. A key component of our work will assess whether national efforts to mitigate effects of the pandemic were effective in reducing adverse health impacts. Innovation: Our work will be the first to evaluate the implementation of a multi-component care coordination intervention to support chronic and preventive care after the disruption to primary care delivery caused by the pandemic. Specific Aims: Aim 1: Identify key factors associated with use of PHI at 1 year as a care coordination intervention to improve coordination of chronic and preventive disease in primary care Aim 2: Understand implementation of the PHI to deliver chronic and preventive care from the perspectives of a) clinic frontline staff (leaders, PCPs, and nurse care managers) and b) Veterans who received the PHI. Aim 3: Examine impact of PHI tool on primary care quality (diabetes, hypertension, and colon cancer screening) and potentially preventable utilization. Methodology: This rapid-cycle evaluation will use both quantitative and qualitative approaches to understanding the implementation and outcomes from the OPC’s PHI intervention. Aim 1: We will use a multi- level modeling approach to examine patient-level variation in rates of PHI-use to identify the extent to which Veteran, provider, or clinic-factors explain this variation. Aim 2: We will conduct semi-structured interviews among clinic staff to understand the implementation of PHI and Veteran experience of PHI-directed care. Aim 3: We will conduct a propensity scored matched analysis, matching patients who received PHI intervention to a comparison group who did not receive PHI to estimate the impacts on quality and utilization measures using a series of difference-in-differences regression models. Implementation/Next Steps: Together, work from these aims will provide key evidence for VA policymakers on the impact of a large-scale care coordination intervention on mitigating the impact COVID-19 on chronic and preventive care.