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

背景：截至2022年5月19日，17，307名患有脊髓损伤和疾病（SCI/D）的退伍军人中有3，427名 在2022财政年度（FY）接受退伍军人健康管理局（VHA）服务的人， 确诊COVID-19检测呈阳性，187例COVID相关死亡。居家令和社交距离 大流行期间的指导方针对这一人群产生了许多影响，包括扰乱医疗保健， 死亡率和发病率增加以及负面的心理社会影响。患有SCI/D的退伍军人是一种独特的 VHA内主要在全国25个SCI/D中心提供服务的人群。患有SCI/D的退伍军人 比其他退伍军人更高的慢性身体状况。关于大流行病对退伍军人影响的研究 SCI/D患者很少，但对研究至关重要，因为这些人将VHA卫生服务作为他们的主要 卫生保健和SCI/D支持的来源（例如，轮椅维修，家庭护理，肠道和膀胱护理， 辅助技术等）。为了告知方案规划和资源分配，必须了解 COVID-19大流行影响了卫生服务的提供、基本资源的获取和死亡率， SCI/D退伍军人的发病率这种解释性的混合方法研究将填补这一知识空白， 检查患者，社区和系统层面的因素与卫生服务护理，物理 和精神健康的结果。 意义：考虑到SCI/D退伍军人慢性身体状况和死亡率的风险增加， VHA必须提供卫生服务，以满足这一人群的需求。这项研究回应了 VA SCI/D国家计划办公室优先支持，促进和维护健康，独立，质量 和生产力的退伍军人与SCI/D在他们的生活。此外，该项目还确定了挑战 在COVID-19大流行期间，SCI/D退伍军人面临的问题，并利用这些结果为卫生服务提供信息 应对未来的紧急事件和全球灾难。 具体目标：该项目的三个目标在科学上很重要，反映了关键退伍军人的广泛投入。 与SCI/D利益相关者就如何提高SCI/D服务质量进行沟通：（1）识别与COVID-19相关的 中断和适应卫生服务的利用和死亡率和发病率之间的退伍军人， SCI/D;（2）Qualitative评估退伍军人和提供者对卫生服务利用的看法 在COVID-19大流行期间发生的变化以及对死亡率和发病率的后续影响;以及（3）检查 退伍军人在COVID-19大流行期间的经历和决策。 方法：我们的研究是由国际功能，残疾和健康分类指导的 概念框架。在目标1中，我们将估计卫生服务利用、发病率、 以及大流行开始前一年和开始后第1年和第2年的死亡率。我们亦会研究是否有 是退伍军人，SCI/D和VHA以及社区因素的时间段之间的差异。最后我们将 对中断护理模式进行探索性分析（2020财年n= 18，331）。目标2将是进行重点 SCI/D退伍军人组（n=4组，每组约3-5名退伍军人）和VHA提供者 为这些退伍军人提供医疗保健服务（n=2组，每组约3-5名提供者）。至于目标3，我们会进行 对使用VHA卫生服务的SCI/D退伍军人进行的一项全国性调查（n=~ 6，100，约占 17，307名目前健在的SCI/D退伍军人由国家SCI/D登记处确定）。 后续步骤/实施：结果将对SCI/D国家项目办公室具有直接价值， SCI/D退伍军人的卫生服务需求，并将用于制定加强应急措施 为未来的灾难做好准备。这些信息将对SCI/D产生广泛和长期的影响 护理系统，信息获取改善项目，远程保健服务扩展，业绩衡量 开发、VHA入组和医疗保健预测建模（20年以上时间框架）。

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).