Impact of the Coronavirus Disease 2019 Pandemic on Cardiovascular HealthcareUtilization, Quality of Care, and Clinical Outcomes

2019 年冠状病毒病大流行对心血管医疗保健利用、护理质量和临床结果的影响

• 批准号: 10643612
• 负责人: Paul Laurence Hess
• 金额: --
• 依托单位: VA EASTERN COLORADO HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10643612
• 关键词: Acute myocardial infarction; Admission activity; Age; Ambulatory Care Facilities; Atrial Fibrillation; COVID-19; COVID-19 pandemic; COVID-19 pandemic effects; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Clinic Visits; Clinical; Clinical assessments; Cohort Studies; Consensus; Coronary; Coronary Arteriosclerosis; Data; Data Sources; Diagnosis; Diagnostic tests; Discipline; Ensure; Equity; Ethnic Origin; Evaluation; Federal Government; Future; Gender; Guidelines; Health Personnel; Healthcare; Healthcare Systems; Heart Diseases; Heart failure; Hospitalization; Hospitals; Inpatients; Integrated Health Care Systems; International; Investigation; Mediation; Methodology; Modeling; Outcome; Outpatients; Patient Admission; Patients; Pharmaceutical Preparations; Policies; Principal Investigator; Procedures; Process; Professional Organizations; Quality of Care; Race; Recommendation; Reporting; Research; Research Personnel; Resources; Sample Size; Standardization; Subgroup; System; Time; United States; United States Department of Veterans Affairs; Vascularization; Veterans; Veterans Health Administration; Virus; Vulnerable Populations; Work; adverse outcome; cardiovascular health; care delivery; clinical risk; cohort; data warehouse; evidence base; follow-up; health care delivery; health care quality; health care service utilization; health equity; improved; improved outcome; inpatient service; medical specialties; mortality; mortality risk; pandemic disease; pandemic potential; patient safety; percutaneous coronary intervention; post-COVID-19; post-pandemic; pre-pandemic; programs; racial difference; research clinical testing; sex; tool

Background: During the coronavirus disease 2019 (COVID-19) pandemic, Veterans have deferred inpatient care such as coronary revascularization in the context of an acute myocardial infarction. Simultaneously, cardiovascular care has been disrupted, with clinicians less likely to prescribe guideline indicated medications for common cardiovascular conditions such as stable coronary artery disease or heart failure. Excess deaths have also occurred during the COVID-19 pandemic, particularly among vulnerable populations, raising the possibility of suboptimal healthcare utilization or quality of care among those not directly infected by the virus. However, the extent to which cardiovascular healthcare utilization and quality of care have decreased during the pandemic compared with preceding time periods and whether these changes have impacted Veterans’ risk of mortality is unknown. Significance: Cardiovascular disease is the most common condition in the United States and the leading cause of excess, non-COVID deaths during the early pandemic. The proposed work may identify gaps in VA healthcare utilization and quality of care with the potential to directly inform national improvements in cardiovascular care for Veterans, leading to more accessible, higher-quality, more equitable care in the future. In addition, the evaluation of care for cardiovascular disease could serve as a model for future research in other disciplines within Veterans Affairs medical specialty care. Specific Aims: Aim 1: Compare inpatient and outpatient utilization (clinic visits / hospitalizations / diagnostic testing / procedural care) among Veterans with common cardiovascular diagnoses (atrial fibrillation / coronary artery disease / heart failure) during the COVID-19 pandemic compared with expected utilization based on the corresponding 3-year period preceding the pandemic. Aim 2: Compare quality of care (guideline indicated medication / transitions of care) among Veterans with common cardiovascular diagnoses (atrial fibrillation / coronary artery disease / heart failure) during the COVID- 19 pandemic with that expected based on the corresponding 3-year period preceding the pandemic. Aim 3: Evaluate whether potential pandemic-related changes in healthcare utilization and/or process of care quality metrics are associated with an increased risk for the clinical outcomes of all-cause mortality and/or cardiovascular mortality among Veterans with common cardiovascular diagnoses. Methodology: We propose an observational, retrospective, national cohort study of Veterans with cardiovascular disease. The primary data sources will consist of the VA Corporate Data Warehouse (CDW) and the Non-VA Care Program Integrity Tools (PIT) system. Using indirect standardization, we will compare potential decreases in cardiovascular healthcare utilization and quality of care and a potential increase in mortality to that which occurred prior to the pandemic, performing subgroup analyses focused on age, sex and gender, and race and ethnicity as allowed by sample sizes. In mediation analyses, we will then assess whether the changes in utilization and quality of care were associated with an increased risk of mortality. Next Steps/Implementation: A stakeholder advisory panel, led by VA operational leaders, investigators, and Veterans, will be convened to develop comprehensive recommendations to optimize the access, quality, and equity of VA cardiovascular care and guide VA policies in the late-COVID-19 and/or post-COVID-19 pandemic period.

背景：在2019年冠状病毒病（COVID-19）大流行期间，退伍军人推迟住院 在急性心肌梗死的情况下进行冠状动脉血运重建等护理。与此同时， 心血管护理已经中断，临床医生不太可能开指南指示的药物 用于常见的心血管疾病，如稳定型冠状动脉疾病或心力衰竭。超额死亡 在2019冠状病毒病大流行期间也发生了这种情况，特别是在脆弱人群中， 在未直接感染病毒的人群中，可能存在医疗保健利用或护理质量欠佳的情况。 然而，心血管保健利用率和护理质量在一定程度上下降， 大流行与以前的时间段相比，以及这些变化是否影响了退伍军人的风险 死亡率未知。 意义：心血管疾病是美国最常见的疾病， 在大流行早期，非COVID死亡人数过多的原因。拟议的工作可能会发现VA的差距 医疗保健利用率和护理质量，有可能直接为国家改善提供信息， 为退伍军人提供心血管护理，从而在未来实现更容易获得，更高质量，更公平的护理。 此外，对心血管疾病护理的评估可以作为未来研究的模型， 退伍军人事务部医疗专业护理内的其他学科。 具体目标：目标1：比较住院患者和门诊患者的利用率（门诊访视/住院/诊断 常见心血管疾病（房颤/冠状动脉疾病）的退伍军人 2019冠状动脉疾病/心力衰竭）的使用率与基于 大流行前三年的相应时期。 目标2：比较退伍军人的护理质量（指南指示的药物/护理过渡）， COVID-19期间常见的心血管疾病诊断（房颤/冠状动脉疾病/心力衰竭） 于二零一九年十二月三十一日，本集团之预期信贷亏损为19大流行，而预期信贷亏损乃基于大流行前三年之相应期间。 目标3：评估卫生保健利用和/或护理过程中是否存在潜在的大流行相关变化 质量指标与全因死亡和/或 常见心血管疾病退伍军人的心血管死亡率。 方法：我们提出了一项观察性，回顾性，国家队列研究的退伍军人与 心血管疾病主要数据源将包括VA公司数据仓库（CDW） 和非VA护理计划完整性工具（PIT）系统。使用间接标准化，我们将比较 心血管医疗保健利用率和护理质量可能下降， 死亡率与大流行之前发生的死亡率相比，进行亚组分析，重点是年龄、性别和 性别、人种和种族（样本量允许）。在调解分析中，我们将评估 利用率和护理质量的变化是否与死亡风险的增加有关。 后续步骤/实施：由VA运营负责人、调查人员和 退伍军人，将召集制定全面的建议，以优化访问，质量， VA心血管护理的公平性，并在COVID-19后期和/或COVID-19大流行后指导VA政策 期