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，17307名患有脊髓损伤和疾病(SCI/D)的退伍军人中有3427人 在2022财年(FY)接受退伍军人健康管理局(VHA)服务的人有 新冠肺炎检测确认为阳性，有187例与新城疫相关的死亡。居家订单与社交距离 大流行期间的指导方针对这一人群产生了许多影响，包括扰乱了医疗保健， 死亡率和发病率的增加以及负面的心理社会影响。患有SCI/D的退伍军人是独一无二的 VHA内的人口，主要在全国25个SCI/D中心提供服务。患有SCI/D的退伍军人 比其他退伍军人有更高的慢性身体状况。大流行对退伍军人影响的研究 对SCI/D的研究很少，但很关键，因为这些人利用VHA医疗服务作为他们的主要 卫生保健和SCI/D支持的来源(例如，轮椅修复、家庭护理、肠道和膀胱护理、 辅助技术等)。要为计划规划和资源分配提供信息，必须了解如何 新冠肺炎大流行影响了卫生服务的提供、基本资源的获得和死亡率 患有脊髓损伤/D的退伍军人中的发病率这项解释性混合方法研究将通过以下方式填补这一知识空白 检查患者、社区和系统层面的因素，这些因素与医疗服务、医疗保健、身体状况 SCI/D退伍军人的心理健康状况。 意义：鉴于患有SCI/D的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 生活，以及患有SCI/D的退伍军人一生的生产力。此外，该项目确定了挑战 新冠肺炎大流行期间患有SCI/D的退伍军人所面临的挑战，并利用这些结果为卫生服务部门提供信息 为未来的紧急事件和全球灾难做准备。 具体目标：该项目的三个目标具有重要的科学意义，并反映了关键老兵的广泛投入 和SCI/D利益相关者关于如何提高SCI/D服务质量：(1)确定与新冠肺炎相关的 退伍军人中卫生服务利用的中断和适应以及死亡率和发病率 SCI/D；(2)定性评估退伍军人和医疗服务提供者对卫生服务利用的看法 新冠肺炎大流行期间的变化及其对死亡率和发病率的影响；和(3)检查 退伍军人在新冠肺炎疫情期间的经历和决策。 研究方法：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大流行开始后第一年和第二年的死亡率。我们还将检查是否有 是退伍军人、SCI/D和VHA之间的时间段差异，以及社区因素。最后，我们会 对中断的护理模式进行探索性分析(20财年n=18,331)。目标2将是进行聚焦 有SCI/D退伍军人的组(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的医疗保健服务(n=2组，每组约3-5个提供者)。对于目标3，我们将进行 一项针对患有SCI/D的退伍军人进行的全国性调查，他们使用VHA医疗服务(n=~6,100人，约占35% 目前有17,307名患有SCI/D的退伍军人被国家SCI/D登记处确认为SCI/D)。 下一步/实施：结果将对SCI/D国家方案办公室具有直接价值，以确定 SCI/D退伍军人的卫生服务需求，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、告知准入改进项目、远程医疗服务扩展、绩效衡量 发展，以及VHA登记和医疗保健预测建模(20年以上的时间框架)。