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Health Policy

Assessment of Changes in US Veterans Health Administration Care Delivery Methods During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: October 14, 2021

Research Letter

Article Information and Disclosures

Liam Rose, PhD^1,2;

Linda Diem Tran, PhD^1,2;

Steven M. Asch, MD, MPH^3,4;

Anita Vashi, MD, MPH^3,5

Author Affiliations

¹Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
²Stanford Surgery Policy Improvement and Education Center, Stanford Medicine, Stanford University, Stanford, California
³Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
⁴Division of Primary Care and Population Health, Stanford Medicine, Stanford University, Stanford, California
⁵Department of Emergency Medicine, University of California, San Francisco

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The Veterans Health Administration (VHA) manages an integrated health care system that has expenditures of nearly $100 billion per year and serves more than 9 million enrollees.¹ Like other health care systems, the VHA has faced unprecedented challenges in responding to the COVID-19 pandemic. Although its large size, diverse operating environments, and geographically dispersed patient population make it difficult for the VHA to pivot nimbly and ensure access to care, this health system was able to leverage its existing infrastructure and prior planning to rapidly scale virtual care services (ie, telephone and video) for enrollees in 2020.²^,3 In this study, we took a broad look at how VHA care patterns, including all forms of care either purchased (known as community care) or provided by the VHA, have shifted in association with the COVID-19 pandemic.

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Article Information

Accepted for Publication: August 10, 2021.

Published: October 14, 2021. doi:10.1001/jamanetworkopen.2021.29139

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Rose L et al. JAMA Network Open.

Corresponding Author: Liam Rose, PhD, Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, 795 Willow Rd, Bldg 324, Menlo Park, CA 94025 (liamrose@stanford.edu).

Author Contributions: Dr Rose and Dr Tran had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Rose, Tran, Vashi.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Rose, Vashi.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Rose, Tran.

Obtained funding: Vashi.

Administrative, technical, or material support: Rose.

Supervision: Rose, Asch, Vashi.

Conflict of Interest Disclosures: Dr Vashi reported receiving grants from the US Department of Veterans Affairs Health Services Research and Development Service. All authors reported receiving grants from and are employed by the US Department of Veterans Affairs. No other disclosures were reported.

Funding/Support: This study was funded by US Department of Veterans Affairs Health Services Research and Development Service Individual Investigator Research Award 16-266 (grant 1101HX002362-01A2 [Dr Vashi]).

Role of the Funder/Sponsor: The US Department of Veterans Affairs Health Services Research and Development Service had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References

US Department of Veterans Affairs. FY2022 budget submission: budget in brief. May 2021. Accessed August 9, 2021. https://www.va.gov/budget/docs/summary/fy2022VAbudgetInBrief.pdf

Ferguson JM , Jacobs J , Yefimova M , Greene L , Heyworth L , Zulman DM . Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization. J Am Med Inform Assoc. 2021;28(3):453-462. doi:10.1093/jamia/ocaa284 PubMed Google Scholar Crossref

Baum A , Kaboli PJ , Schwartz MD . Reduced in-person and increased telehealth outpatient visits during the COVID-19 pandemic. Ann Intern Med. 2021;174(1):129-131. doi:10.7326/M20-3026 PubMed Google Scholar Crossref

Mehrotra A , Chernew ME , Linetsky D , Hatch H , Cutler DA , Schneider EC . The impact of COVID-19 on outpatient visits in 2020: visits remained stable, despite a late surge in cases. Commonwealth Fund. February 2021. Accessed August 9, 2021. https://www.commonwealthfund.org/publications/2021/feb/impact-covid-19-outpatient-visits-2020-visits-stable-despite-late-surge

Heist T , Schwartz K , Butler S . Trends in overall and non-COVID-19 hospital admissions. KFF. February 18, 2021. Accessed August 9, 2021. https://www.kff.org/health-costs/issue-brief/trends-in-overall-and-non-covid-19-hospital-admissions/

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.