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

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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).