Disruption of Health Services: The Impact of COVID-19 on Veterans with SCI/D

卫生服务中断：COVID-19 对 SCI/D 退伍军人的影响

• 批准号: 10637275
• 负责人: Andrea K Finlay
• 金额: --
• 依托单位: JAMES J PETERS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10637275
• 关键词: Address; Awareness; Bladder; Businesses; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 risk; COVID-19 test; Caregiver support; Caregivers; Caring; Cessation of life; Chronic; Chronic Disease; Classification; Communities; Complex; Data; Decision Making; Development; Disasters; Disease; Disease Management; Economics; Emergency Situation; Emergency response; Emotional; Enrollment; Evaluation; Event; Focus Groups; Future; Goals; Guidelines; Health; Health Personnel; Health Services; Health Services Accessibility; Health Services Administration; Health Services Needs; Healthcare; Home; Housing; Hurricane; Improve Access; Incidence; Individual; International; Intestines; Knowledge; Learning; Measures; Medical; Mental Depression; Mental Health; Methodology; Methods; Modeling; Morbidity - disease rate; Natural Disasters; Nature; New York; Newly Diagnosed; Outcome; Patients; Pattern; Performance; Persons; Policies; Population; Primary Care; Productivity; Provider; Quality of life; Registries; Research; Resource Allocation; Resources; Risk; SARS-CoV-2 positive; Self-Help Devices; Services; Site; Social Distance; Social isolation; Source; Spinal cord injury; Stress; Surveys; System; Systems Integration; Time; Transportation; Treatment/Psychosocial Effects; United States; Variant; Veterans; Veterans Health Administration; Vulnerable Populations; Wheelchairs; World Health Organization; care delivery; care systems; community-level factor; coronavirus disease; decubitus ulcer; disability; emergency preparedness; experience; food insecurity; health care delivery; health care service; health service use; high risk; improved; inpatient service; medical specialties; mortality; mortality risk; operation; pandemic disease; pandemic impact; patient home care; physical conditioning; primary care practice; programs; psychosocial; repaired; research and development; response; screening; stay-at-home order; telehealth

Background: As of May 19, 2022, 3,427 of the 17,307 Veterans living with spinal cord injury and disorders (SCI/D) who have received services from the Veterans Health Administration (VHA) in fiscal year (FY) 2022 had a confirmed positive COVID-19 test, with 187 COVID-related deaths. Stay-at-home orders and social distancing guidelines during the pandemic have had numerous effects on this population including disrupting healthcare, increased mortality and morbidity as well as negative psychosocial effects. Veterans with SCI/D are a unique population within the VHA who are primarily served at 25 SCI/D Centers nationally. Veterans with SCI/D have higher rates of chronic physical conditions than other Veterans. Research on the pandemic impact on Veterans with SCI/D is scant but critical to study because these individuals utilize VHA health services as their primary source of health care and SCI/D support (e.g., wheelchair repair, home-based care, bowel and bladder care, assistive technology, etc.). To inform program planning and resource allocation, it is essential to know how the COVID-19 pandemic has impacted health service delivery, access to essential resources, and mortality and morbidity among Veterans with SCI/D. This explanatory mixed methods study will fill this gap in knowledge by examining patient-, community-, and system-level factors related to changes in health services care, physical and mental health outcomes in Veterans with SCI/D. Significance: Given the elevated risk of chronic physical conditions and mortality for Veterans with SCI/D, it is imperative that VHA provides health services to address the needs of this population. This study responds to the VA SCI/D National Program Office priorities to support, promote, and maintain the health, independence, quality of life, and productivity of Veterans with SCI/D throughout their lives. Further, this project identifies challenges faced by Veterans with SCI/D during the COVID-19 pandemic and utilizes these results to inform health services for future emergency events and global disasters. Specific Aims: The project’s three aims are scientifically important and reflect extensive input from key Veteran and SCI/D stakeholders regarding how to improve the quality of SCI/D services: (1) Identify COVID-19 related disruptions and adaptations in health services utilization and mortality and morbidity among Veterans with SCI/D; (2) Qualitatively evaluate Veterans’ and providers’ perspectives on how health services utilization changed during the COVID-19 pandemic and the subsequent impact on mortality and morbidity; and (3) Examine Veterans experiences and decision-making during the COVID-19 pandemic. Methodology: Our study is guided by the International Classification of Functioning, Disability, and Health conceptual framework. In Aim 1, we will estimate incidence rate ratios of health services utilization, morbidity, and mortality in the year prior and years 1 and 2 after the start of the pandemic. We will also examine if there are differences between the time periods by Veteran, SCI/D and VHA, and community factors. Finally, we will conduct exploratory analyses of patterns of disrupted care (n=18,331 in FY20). Aim 2 will be to conduct focus groups with Veterans with SCI/D (n=4 groups with ~3-5 Veterans per group) and VHA providers who deliver healthcare services for these Veterans (n=2 groups with ~3-5 providers per group). For Aim 3, we will conduct a national survey with Veterans with SCI/D who use VHA health services (n=~6,100, which approximates 35% of the 17,307 currently living Veterans with SCI/D identified by the National SCI/D Registry). Next Steps/Implementation: Results will be of immediate value to the SCI/D National Program Office to identify health services needs for Veterans with SCI/D and will be used to develop measures for enhanced emergency preparedness for future disasters. This information will have broad and long-ranging impacts on the SCI/D System of Care, informing access improvement projects, telehealth service expansion, performance measures development, and VHA enrollment and health care projection modeling (20+ year timeframe).

背景：截至2022年5月19日，有脊髓损伤和疾病（SCI/D）的17,307名退伍军人中有3,427 在2022年（FY）的财政年度（FY）的退伍军人卫生管理局（VHA）的服务中 确认为阳性Covid-19检验，有187例与共同相关的死亡。在家订单和社会疏远 大流行期间的指南对这一人群有许多影响，包括破坏医疗保健， 死亡率和发病率增加以及负面的社会心理影响。带有科幻/D的退伍军人是独特的 VHA中主要在全国范围内以25个SCI/D中心服务的人口。有科幻/D的退伍军人 慢性身体状况比其他退伍军人更高。研究大流行对退伍军人的影响 SCI/D很少，但对于学习至关重要，因为这些人利用VHA卫生服务作为其主要 医疗保健和科学/D支持的来源（例如，轮椅维修，家庭护理，肠和膀胱护理， 辅助技术等）。为了告知计划计划和资源分配，必须知道如何知道 COVID-19大流行已经影响了卫生服务的提供，获得基本资源以及死亡率以及 具有科幻/d的退伍军人的发病率。这项爆炸性混合方法研究将通过 检查患者，社区和系统级别的因素，与卫生服务的变化有关 和SCI/D的退伍军人的心理健康成果。 意义：鉴于SCI/D的退伍军人的慢性身体状况和死亡率的风险升高，这是 VHA必须提供健康服务以满足该人群的需求。这项研究对 VA Sci/D国家计划办公室优先事项以支持，促进和维持健康，独立性，质量 生命，一生中有科幻的退伍军人的生产力。此外，该项目确定了挑战 由经验丰富的退伍军人在19日期大流行期间，并利用这些结果为卫生服务提供了信息 对于未来的紧急事件和全球灾难。 具体目的：该项目的三个目标在科学上很重要，并反映了主要退伍军人的广泛投入 关于如何提高科幻服务质量的科学/D利益相关者：（1）确定COVID-19相关 退伍军人的卫生服务利用以及死亡率和发病率的中断和适应 科幻/d; （2）定性评估退伍军人和提供者对健康服务如何利用的看法 在Covid-19的大流行期间发生了变化，以及随后对死亡率和发病率的影响； （3）检查 退伍军人经历和决策在19日期大流行期间。 方法论：我们的研究以国际功能，残疾和健康分类为指导 概念框架。在AIM 1中，我们将估计健康服务利用率，发病率，发病率的事件率比率 和前一年的死亡率以及大流行开始后的第1和2年。我们还将检查是否在那里 是资深人士，SCI/D和VHA的时间段之间的差异以及社区因素。最后，我们会的 进行破坏护理模式的探索性分析（n = 18,331财年）。目标2将是进行重点 具有SCI/D的退伍军人组（n = 4组，每组约3-5名退伍军人）和VHA提供者 这些退伍军人的医疗服务（n = 2组，每组约3-5个提供者）。对于AIM 3，我们将进行 与使用VHA卫生服务的SCI/D的退伍军人进行的全国调查（n = 〜6,100，约占35％ 目前由国家科幻注册中心确定的17,307名活着的老兵。 下一步/实施：结果将对SCI/D国家计划办公室具有直接的价值来确定 SCI/D的退伍军人的卫生服务需求，将用于制定措施以加强紧急情况 为将来的灾难做准备。这些信息将对SCI/D产生广泛而长期的影响 护理系统，通知访问改进项目，远程医疗服务扩展，绩效指标 开发以及VHA入学率和医疗保健投影建模（20年以上的时间范围）。