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Health Policy

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

JAMA Network Open

Published Online: September 20, 2022

Research Letter

Article Information and Disclosures

Kevin N. Griffith, PhD^1,2;

Daniel A. Asfaw, PhD^1,3;

Rachel G. Childers, PhD⁴;

Andrew P. Wilper, MD^5,6

Author Affiliations

¹Partnered Evidence-Based Policy Resource Center, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
²Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
³Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
⁴Department of Business Administration and Economics, Presbyterian College, Clinton, South Carolina
⁵Veterans Affairs Boise Healthcare System, Boise, Idaho
⁶Department of Medicine, University of Washington, Seattle

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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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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

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

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

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

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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

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 PubMed Google Scholar Crossref

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.