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，退伍军人推迟了住院治疗 同时进行护理，例如急性心肌梗塞的冠状动脉血运重建术。 心血管护理受到干扰，主教不太可能开出指南指示的药物 用于常见的心血管疾病，例如稳定的冠状动脉疾病或心力衰竭。 在 COVID-19 大流行期间也发生过这种情况，特别是在弱势群体中，这提高了 对于那些没有直接感染病毒的人来说，医疗保健利用或护理质量可能不理想。 然而，心血管医疗保健的利用率和护理质量在这一时期有所下降。 与之前时期相比，大流行的情况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，也是最主要的疾病 拟议的工作可能会找出 VA 的差距。 医疗保健利用和护理质量有可能直接影响国家的改善 为退伍军人提供心血管护理，从而在未来提供更容易获得、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：比较住院病人和门诊病人的利用率（门诊就诊/住院/诊断 患有常见心血管疾病（心房颤动/冠状动脉疾病）的退伍军人中的测试/程序护理） COVID-19 大流行期间的动脉疾病/心力衰竭）与基于 大流行之前的相应三年期间。 目标 2：比较退伍军人和退伍军人的护理质量（指南指示药物/护理过渡） 新冠肺炎期间常见的心血管疾病诊断（心房颤动/冠状动脉疾病/心力衰竭） 19 大流行病与根据大流行病发生前相应三年期间的预期。 目标 3：评估医疗保健利用和/或护理过程中是否存在与大流行相关的潜在变化 质量指标与全因死亡率和/或临床结果的风险增加相关 患有常见心血管疾病的退伍军人的心血管死亡率。 方法：我们建议对退伍军人进行一项观察性、回顾性、全国队列研究 主要数据源将包括 VA 企业数据仓库 (CDW)。 和非 VA 护理计划完整性工具 (PIT) 系统，我们将使用间接标准化进行比较。 心血管医疗保健利用率和护理质量的潜在下降以及潜在的增加 死亡率与大流行之前发生的死亡率相比，进行了侧重于年龄、性别和年龄的亚组分析 在中介分析中，我们将评估样本量允许的性别、种族和民族。 护理利用率和质量的变化是否与死亡风险增加相关。 后续步骤/实施：由 VA 运营领导、调查人员和领导者领导的利益相关者咨询小组 退伍军人将被召集起来制定全面的建议，以优化准入、质量和 VA 心血管护理的公平性并指导 VA 在 COVID-19 晚期和/或 COVID-19 大流行后的政策 时期。