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Changes in US Veterans’ Access to Specialty Care During the COVID-19 Pandemic

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

The Veterans Health Administration (VHA) began preparing for the COVID-19 pandemic in January 2020 and implemented extensive measures to reduce the spread of SARS-CoV-2 within its facilities.1 Measures included national screening, testing and isolation protocols, mandatory training, communication of safety information to patients, and increased telemedicine use.1,2 Although these measures reduced in-person visits3 and increased telehealth volume,4 their association with specialty care volume is unknown. Pandemic-related changes in referral patterns may have important implications for downstream health outcomes. In this study, we identified changes in referral volume and wait times for veterans seeking care from VHA or community-based specialists.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: August 3, 2022.

Published: September 20, 2022. doi:10.1001/jamanetworkopen.2022.32515

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Griffith KN et al. JAMA Network Open.

Corresponding Author: Kevin N. Griffith, PhD, Department of Health Policy, Vanderbilt University Medical Center, 2525 West End Ave, Ste 1204, Nashville, TN 37203 (kevin.griffith@vumc.org).

Author Contributions: Drs Griffith and Asfaw 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: Griffith, Asfaw, Childers.

Acquisition, analysis, or interpretation of data: Griffith, Asfaw, Wilper.

Drafting of the manuscript: Griffith, Childers.

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

Statistical analysis: Griffith, Asfaw.

Administrative, technical, or material support: Childers, Wilper.

Supervision: Griffith.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by grant PEC 16-001 from the Department of Veterans Affairs Quality Enhancement Research Initiative and by grant K12 HS026395 from the Agency for Healthcare Research and Quality (Dr Griffith).

Role of the Funder/Sponsor: The sponsors 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
1.
US Government Accountability Office. COVID-19: implementation and oversight of preparedness strategies at Veterans Affairs medical centers. June 30, 2021. Accessed October 2, 2021. https://www.gao.gov/products/gao-21-514
2.
Veterans Health Administration Office of Emergency Management. COVID-19 response plan. March 23, 2020. Accessed October 2, 2021. https://www.va.gov/opa/docs/VHA_COVID_19_03232020_vF_1.pdf
3.
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 PubMedGoogle ScholarCrossref
4.
Connolly  SL , Stolzmann  KL , Heyworth  L , Weaver  KR , Bauer  MS , Miller  CJ .  Rapid increase in telemental health within the Department of Veterans Affairs during the COVID-19 pandemic.   Telemed J E Health. 2021;27(4):454-458. doi:10.1089/tmj.2020.0233 PubMedGoogle ScholarCrossref
5.
Griffith  KN , Ndugga  NJ , Pizer  SD .  Appointment wait times for specialty care in Veterans Health Administration facilities vs community medical centers.   JAMA Netw Open. 2020;3(8):e2014313. doi:10.1001/jamanetworkopen.2020.14313 PubMedGoogle ScholarCrossref
6.
Feyman  Y , Legler  A , Griffith  KN .  Appointment wait time data for primary & specialty care in Veterans Health Administration facilities vs community medical centers.   Data Brief. 2021;36:107134. doi:10.1016/j.dib.2021.107134 PubMedGoogle ScholarCrossref
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