1
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Haderlein TP, Guzman-Clark J, Dardashti NS, McMahon N, Duran EL, Haun JN, Robinson SA, Blok AC, Cutrona SL, Lindsay JA, Armstrong CM, Nazi KM, Shimada SL, Wilck NR, Reilly E, Kuhn E, Hogan TP. Improving Veteran Engagement with Virtual Care Technologies: a Veterans Health Administration State of the Art Conference Research Agenda. J Gen Intern Med 2024; 39:21-28. [PMID: 38252243 PMCID: PMC10937853 DOI: 10.1007/s11606-023-08488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/13/2023] [Indexed: 01/23/2024]
Abstract
Although the availability of virtual care technologies in the Veterans Health Administration (VHA) continues to expand, ensuring engagement with these technologies among Veterans remains a challenge. VHA Health Services Research & Development convened a Virtual Care State of The Art (SOTA) conference in May 2022 to create a research agenda for improving virtual care access, engagement, and outcomes. This article reports findings from the Virtual Care SOTA engagement workgroup, which comprised fourteen VHA subject matter experts representing VHA clinical care, research, administration, and operations. Workgroup members reviewed current evidence on factors and strategies that may affect Veteran engagement with virtual care technologies and generated key questions to address evidence gaps. The workgroup agreed that although extensive literature exists on factors that affect Veteran engagement, more work is needed to identify effective strategies to increase and sustain engagement. Workgroup members identified key priorities for research on Veteran engagement with virtual care technologies through a series of breakout discussion groups and ranking exercises. The top three priorities were to (1) understand the Veteran journey from active service to VHA enrollment and beyond, and when and how virtual care technologies can best be introduced along that journey to maximize engagement and promote seamless care; (2) utilize the meaningful relationships in a Veteran's life, including family, friends, peers, and other informal or formal caregivers, to support Veteran adoption and sustained use of virtual care technologies; and (3) test promising strategies in meaningful combinations to promote Veteran adoption and/or sustained use of virtual care technologies. Research in these priority areas has the potential to help VHA refine strategies to improve virtual care user engagement, and by extension, outcomes.
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Affiliation(s)
- Taona P Haderlein
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, Los Angeles, CA, USA.
- Department of Veterans Affairs, Veterans Emergency Management Evaluation Center, Sepulveda, CA, USA.
| | | | - Navid S Dardashti
- NYU Grossman School of Medicine, New York, NY, USA
- VA New York Harbor Healthcare System, New York, NY, USA
| | - Nicholas McMahon
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | | | - Jolie N Haun
- Research and Development Service, James A. Haley Veterans Hospital, Tampa, FL, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Stephanie A Robinson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Amanda C Blok
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States Department of Veterans Affairs, Ann Arbor, MI, USA
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jan A Lindsay
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- Rice University's Baker Institute for Public Policy, Houston, TX, USA
| | - Christina M Armstrong
- Connected Health Implementation Strategies, Office of Connected Care, Veterans Health Administration, Washington, DC, USA
| | - Kim M Nazi
- Trilogy Federal, LLC, Arlington, VA, USA
- KMN Consulting Services, LTD, Coxsackie, NY, USA
| | - Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Nancy R Wilck
- Connected Health Implementation Strategies, Office of Connected Care, Veterans Health Administration, Washington, DC, USA
| | - Erin Reilly
- VISN 1 Mental Illness Research, Education, and Clinical Center (MIRECC), VA Bedford Healthcare System, Bedford, MA, USA
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Eric Kuhn
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Peter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
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2
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Haderlein TP, Hamilton AB, Masheb RM, Mullur R, Lam CA, Washington DL. Racial and Ethnic Variation in Healthcare Utilization Before and During the COVID-19 Pandemic: Differential Effects for Overall Versus Telehealth Care. J Gen Intern Med 2024:10.1007/s11606-023-08592-8. [PMID: 38228985 DOI: 10.1007/s11606-023-08592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/28/2023] [Indexed: 01/18/2024]
Affiliation(s)
- Taona P Haderlein
- VHA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy (CSHIIP), Greater Los Angeles VA Healthcare System, 11301 Wilshire Blvd, Bldg 206 (151), Los Angeles, CA, 90073, USA.
- Veterans Emergency Management Evaluation Center, U.S Department of Veterans Affairs, North Hills, CA, USA.
| | - Alison B Hamilton
- VHA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy (CSHIIP), Greater Los Angeles VA Healthcare System, 11301 Wilshire Blvd, Bldg 206 (151), Los Angeles, CA, 90073, USA
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Robin M Masheb
- VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rashmi Mullur
- Telehealth Service, VA Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Division of Endocrinology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | | | - Donna L Washington
- VHA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy (CSHIIP), Greater Los Angeles VA Healthcare System, 11301 Wilshire Blvd, Bldg 206 (151), Los Angeles, CA, 90073, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
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Shannon EM, Haderlein TP, Neil Steers W, Wong MS, Washington DL. Comparison of Racial and Ethnic Disparities in COVID-19 Mortality Between Veterans Health Administration and US Populations. J Gen Intern Med 2023; 38:3657-3659. [PMID: 37740169 PMCID: PMC10713933 DOI: 10.1007/s11606-023-08430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Evan M Shannon
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
| | - Taona P Haderlein
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA, USA
| | - W Neil Steers
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Michelle S Wong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
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Bowersox NW, Browne J, Grau PP, Merrill SL, Haderlein TP, Llorente MD, Washington DL. COVID-19 mortality among veterans with serious mental illness in the veterans health administration. J Psychiatr Res 2023; 163:222-229. [PMID: 37230006 PMCID: PMC10171776 DOI: 10.1016/j.jpsychires.2023.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Persons with serious mental illness (SMI: schizophrenia-spectrum disorders, bipolar disorder) experience increased risk of mortality after contracting COVID-19 based on the results of several international evaluations. However, information about COVID-19 mortality risk among patients with SMI in the Veterans Health Administration (VHA) has been limited, precluding identification of protective factors. The current evaluation was conducted to assess COVID-19 mortality risk among VHA patients with SMI and to evaluate potential protective factors in mitigating mortality risk following a positive COVID-19 diagnosis. METHODS National VHA administrative data was used to identify all patients (N = 52,916) who received a positive COVID-19 test result between March 1, 2020, and September 30, 2020. Mortality risk was assessed by SMI status via bivariate comparisons and multivariate regression analyses. RESULTS In unadjusted analyses, VHA patients with SMI overall and patients with bipolar disorder in particular did not experience increased mortality risk in the 30 days following a positive COVID test, although patients with schizophrenia had increased risk. Within adjusted analyses, patients with schizophrenia remained at increased mortality risk (OR = 1.38), but at reduced levels relative to previous evaluations in other healthcare settings. CONCLUSIONS Within VHA, patients with schizophrenia, but not those with bipolar disorder, experience increased mortality risk in the 30 days following a positive COVID-19 test. Large integrated healthcare settings such as VHA may offer services which may protect against COVID-19 mortality for vulnerable groups such as persons with SMI. Additional work is needed to identify practices which may reduce the risk of COVID-19 mortality among persons with SMI.
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Affiliation(s)
- Nicholas W Bowersox
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Julia Browne
- Research Service, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Peter P Grau
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington DC, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephanie L Merrill
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs Central Office, Washington DC, USA
| | - Taona P Haderlein
- Veterans Health Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA; Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, North Hills, CA, USA
| | - Maria D Llorente
- Patient Care Services, Department of Veterans Affairs, Washington DC, USA; Department of Psychiatry, Georgetown University School of Medicine, Washington DC, USA
| | - Donna L Washington
- Veterans Health Administration Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles Geffen School of Medicine, Los Angeles, CA, USA
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Goulet JL, Warren AR, Workman TE, Skanderson M, Farmer MM, Gordon KS, Abel EA, Akgün KM, Bean-Mayberry B, Zeng-Treitler Q, Haderlein TP, Haskell SG, Bastian LA, Womack JA, Post LA, Hwang U, Brandt CA. Variation in firearm screening and access by LGBT status. Acad Emerg Med 2023; 30:420-423. [PMID: 36661348 DOI: 10.1111/acem.14664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/21/2023]
Affiliation(s)
- Joseph L Goulet
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Allison R Warren
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - T Elizabeth Workman
- Biomedical Informatics Center, The George Washington University, Washington, DC, USA
| | | | - Melissa M Farmer
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Kirsha S Gordon
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Erica A Abel
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kathleen M Akgün
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bevanne Bean-Mayberry
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, UCLA-David Geffen School of Medicine, Los Angeles, California, USA
| | - Qing Zeng-Treitler
- Biomedical Informatics Center, The George Washington University, Washington, DC, USA.,Washington DC VA Medical Center, Washington, DC, USA
| | - Taona P Haderlein
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Veterans Affairs, Veterans Emergency Management Evaluation Center (VEMEC), North Hills, California, USA
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Julie A Womack
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Yale School of Nursing, VA Connecticut, West Haven, Connecticut, USA
| | - Lori A Post
- Northwestern University, Chicago, Illinois, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, New York, USA
| | - Cynthia A Brandt
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Healthcare System, West Haven, Connecticut, USA
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6
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Haderlein TP, Dobalian A, Raja PV, Der-Martirosian C. Effects of Virtual Care and Same-Day Access to Integrated Care on Specialty Mental Health Engagement in the Veterans Health Administration. J Prim Care Community Health 2023; 14:21501319231159311. [PMID: 36905315 PMCID: PMC10009030 DOI: 10.1177/21501319231159311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND In the Veterans Health Administration (VA), Primary Care-Mental Health Integration (PC-MHI) clinics offer mental health services embedded in primary care, a strategy shown to reduce overall specialty mental health clinic burden while facilitating prompt referrals when indicated. Among newly initiated patients, same-day access to PC-MHI from primary care increases subsequent specialty mental health engagement. However, the impact of virtual care on the association between same-day access to PC-MHI and subsequent mental health engagement remains unclear. OBJECTIVE To examine the effects of same-day access to PC-MHI and virtual care use on specialty mental health engagement. METHODS We used administrative data from 3066 veterans who initiated mental health care at a large, California VA PC-MHI clinic during 3/1/2018 to 2/28/2022 and had no previous mental health visits for at least 2 years prior to the index appointment. We conducted Poisson regression analyses to examine the effects of same-day access to PC-MHI, virtual access to PC-MHI and their combined effect on subsequent specialty mental health engagement. RESULTS Same-day access to PC-MHI from primary care was positively associated with specialty mental health engagement (IRR = 1.19; 95% CI 1.14-1.24). Virtual access to PC-MHI was negatively associated with specialty mental health engagement (IRR = 0.83; 95% CI 0.79-0.87). The positive effect of same-day access on specialty mental health engagement was smaller among patients who initiated PC-MHI in a virtual visit (IRR = 1.07) compared to in-person visits (IRR = 1.29; 95% CI 1.22-1.36). CONCLUSIONS Although same-day access to PC-MHI increased overall specialty mental health engagement, the magnitude of this effect varied between in-person and virtual modalities. More research is needed to understand mechanisms of the association between virtual care use, same-day access to PC-MHI, and specialty mental health engagement.
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Affiliation(s)
- Taona P. Haderlein
- U.S. Department of Veterans Affairs, North Hills, CA, USA
- VHA HSR&D Center for the Study of Health care Innovation, Implementation, and Policy (CSHIIP), Greater Los Angeles VA Medical Center, Los Angeles, CA, USA
- Taona P. Haderlein, VA Greater Los Angeles Healthcare System, Veterans Emergency Management Evaluation Center, 16111 Plummer Street MS-152, North Hills, CA 91343-2036, USA.
| | - Aram Dobalian
- U.S. Department of Veterans Affairs, North Hills, CA, USA
- Greater Los Angeles VA Medical Center, Los Angeles, CA, USA
| | | | - Claudia Der-Martirosian
- U.S. Department of Veterans Affairs, North Hills, CA, USA
- VHA HSR&D Center for the Study of Health care Innovation, Implementation, and Policy (CSHIIP), Greater Los Angeles VA Medical Center, Los Angeles, CA, USA
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7
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Wong MS, Upchurch DM, Steers WN, Haderlein TP, Yuan AT, Washington DL. The Role of Community-Level Factors on Disparities in COVID-19 Infection Among American Indian/Alaska Native Veterans. J Racial Ethn Health Disparities 2022; 9:1861-1872. [PMID: 34491563 PMCID: PMC8422953 DOI: 10.1007/s40615-021-01123-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES American Indian and Alaska Native (AI/AN) communities have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic. This study examines whether neighborhood characteristics mediate AI/AN versus White-non-Hispanic Veteran COVID-19 infection disparities, and whether mediation differs based on proximity to reservations. METHODS Using Veteran Health Administration's (VHA) national database of VHA users evaluated for COVID-19 infection (3/1/2020-8/25/2020), we examined whether census tract neighborhood characteristics (percent households overcrowded, without complete plumbing, without kitchen plumbing, and neighborhood socioeconomic status [n-SES]) mediated racial disparities in COVID-19 infection, using inverse odds-weighted logistic models controlling for individual-level characteristics. Using moderated mediation analyses, we assessed whether neighborhood mediating effects on disparities differed for those residing in counties containing/near federally recognized tribal lands (i.e., Contract Health Service Delivery Area [CHSDA] counties) versus not. RESULTS The percent of households without complete plumbing, percent without kitchen plumbing, and n-SES partially mediated AI/AN-White-non-Hispanic COVID-19 infection disparities (accounting for 17-35% of disparity) to a similar extent in CHSDA and non-CHSDA counties. The percent of households without kitchen plumbing had stronger mediating effects for CHSDA than non-CHSDA residents. CONCLUSIONS Neighborhood-level social determinants of health may contribute to the disproportionate COVID-19 infection burden on AI/ANs; differences are exacerbated among AI/ANs living near reservations.
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Affiliation(s)
- Michelle S Wong
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Dawn M Upchurch
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - W Neil Steers
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Taona P Haderlein
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Anita T Yuan
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Donna L Washington
- VA HSR&D Center for, the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles Geffen School of Medicine, Los Angeles, CA, USA
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Abstract
OBJECTIVE This study examined the association between serious mental illness diagnoses and COVID-19 vaccination among Veterans Health Administration (VHA) patients. METHODS The sample (N=4,890,693) comprised veterans ages ≥18 years with VHA outpatient visits from March 1, 2018, through February 29, 2020. Veterans with serious mental illness were identified with ICD-10 diagnostic codes from electronic health records of the U.S. Department of Veterans Affairs. Receipt of a VHA COVID-19 vaccine from December 1, 2020, through June 1, 2021, was documented by using procedure codes. Treatment effects estimation with inverse-probability weighting was used to estimate the effects of serious mental illness on COVID-19 vaccine uptake. RESULTS Patients with serious mental illness and patients without serious mental illness were equally likely to receive a vaccination (48% and 46%, respectively; average effect of serious mental illness=-0.4%, 95% confidence interval=-0.8% to 0.1%). CONCLUSIONS VHA outreach activities have contributed to equitable distribution of the COVID-19 vaccine.
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Affiliation(s)
- Taona P Haderlein
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs (VA), North Hills, California (Haderlein, Steers, Dobalian); Health Services Research and Development Center for the Study of Health Care Innovation, Implementation, and Policy, Veterans Health Administration (VHA), Greater Los Angeles VA Medical Center, Los Angeles (Haderlein, Steers); Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis (Dobalian)
| | - W Neil Steers
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs (VA), North Hills, California (Haderlein, Steers, Dobalian); Health Services Research and Development Center for the Study of Health Care Innovation, Implementation, and Policy, Veterans Health Administration (VHA), Greater Los Angeles VA Medical Center, Los Angeles (Haderlein, Steers); Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis (Dobalian)
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, U.S. Department of Veterans Affairs (VA), North Hills, California (Haderlein, Steers, Dobalian); Health Services Research and Development Center for the Study of Health Care Innovation, Implementation, and Policy, Veterans Health Administration (VHA), Greater Los Angeles VA Medical Center, Los Angeles (Haderlein, Steers); Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis (Dobalian)
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9
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Haderlein TP, Wong MS, Jones KT, Moy EM, Yuan AH, Washington DL. Racial/Ethnic Variation in Veterans Health Administration COVID-19 Vaccine Uptake. Am J Prev Med 2022; 62:596-601. [PMID: 34782188 PMCID: PMC8529259 DOI: 10.1016/j.amepre.2021.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/03/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Equitable COVID-19 vaccine access is imperative to mitigating negative COVID-19 impacts among racial/ethnic minorities. U.S. racial/ethnic minorities have lower COVID-19 vaccination rates than Whites despite higher COVID-19 death/case rates. The Veterans Health Administration provides the unique context of a managed care system with few access barriers. This study evaluates race/ethnicity as a predictor of Veterans Health Administration COVID-19 vaccination. METHODS The cohort was composed of Veterans Health Administration outpatient users aged ≥65 years (N=3,474,874). COVID-19 vaccination was assessed between December 14, 2020 and February 23, 2021. Multivariable logistic regressions were conducted, controlling for demographics, medical comorbidity, and influenza vaccination history. Proximity to Indian Health Service Contract Health Service Delivery Areas was tested as a moderator. Data analyses were conducted during 2021. RESULTS Blacks (OR=1.28, 95% CI=1.17, 1.40), Hispanics (OR=1.15, 95% CI=1.05, 1.25), and Asians (OR=1.21, 95% CI=1.02, 1.43) were more likely than Whites to receive Veterans Health Administration COVID-19 vaccinations. American Indian/Alaska Natives were less likely than Whites to receive Veterans Health Administration COVID-19 vaccinations, but only those residing in Contract Health Service Delivery Area counties (OR= 0.58, 95% CI= 0.47, 0.72). Influenza vaccine history positively predicted COVID-19 vaccine uptake (OR= 2.28, 95% CI=2.22, 2.34). CONCLUSIONS In the Veterans Health Administration, compared with the general U.S. population, COVID-19 vaccine receipt is higher among most racial/ethnic minority groups than Whites, suggesting reduced vaccination barriers . The Indian Health Service may provide a safety net for American Indian/Alaska Native populations. Addressing vaccination access barriers in non-Veterans Health Administration settings can potentially reduce racial/ethnic disparities.
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Affiliation(s)
- Taona P Haderlein
- VA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Michelle S Wong
- VA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Kenneth T Jones
- VA Office of Health Equity, Washington, District of Columbia
| | - Ernest M Moy
- VA Office of Health Equity, Washington, District of Columbia
| | - Anita H Yuan
- VA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Donna L Washington
- VA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
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10
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Upchurch DM, Wong MS, Yuan AH, Haderlein TP, McClendon J, Christy A, Washington DL. COVID-19 Infection in the Veterans Health Administration: Gender-specific Racial and Ethnic Differences. Womens Health Issues 2022; 32:41-50. [PMID: 34702652 PMCID: PMC8486675 DOI: 10.1016/j.whi.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/10/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Racial/ethnic minoritized groups, women, and economically disadvantaged groups are disproportionately affected by the COVID-19 pandemic. We investigated racial/ethnic differences by gender in correlates of COVID-19 infection among veterans seeking health care services at the Veterans Health Administration. Little is known about gender-specific factors associated with infection among veterans. This study seeks to fill this gap. METHODS The sample was veterans with results from a COVID-19 test (polymerase chain reaction) conducted at Veterans Health Administration facilities between March 1, 2020, and August 5, 2020, and linked to the Centers for Disease Control and Prevention Social Vulnerability Index data (39,223 women and 316,380 men). Bivariate, multivariate logistic, and predicted probability analyses were conducted. All analyses were stratified by gender. RESULTS Similar percentages of women and men tested positive for COVID-19 (9.6% vs. 10.0%). In multivariate analysis, compared with non-Hispanic White women, American Indian/Alaska Native, Black, and Hispanic women all had significantly higher odds of infection. Similar racial/ethnic differences were found for men. Both older men and women (>40 years) had lower odds of infection, but the age cut points differed (40 for women, 55 for men). Men 80 years and older had a higher odds than those aged less than 40 years of age. For men, but not for women, being employed (vs. unemployed) was associated with an increased odds of infection, and having comorbidities was associated with decreased odds. There were significant differences within and across gender-by-race/ethnicity in infection, after adjusting for covariates. CONCLUSIONS American Indian/Alaska Native, Hispanic, and Black women and men veterans are disproportionately impacted by COVID-19 infection. Widespread testing and tracking, education, and outreach regarding COVID-19 mitigation and vaccination efforts are recommended.
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Affiliation(s)
- Dawn M Upchurch
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California.
| | - Michelle S Wong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Anita H Yuan
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Taona P Haderlein
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Juliette McClendon
- National Center for PTSD, Women's Health Science Division, VA Boston Health Care System, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Alicia Christy
- Women's Health Services, Veterans Health Administration, Washington, District of Columbia
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles Geffen School of Medicine, Los Angeles, California
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11
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Haderlein TP, Dobalian A, Raja PV, Der-Martirosian C. Association Between Virtual Care Use and Same-Day Primary Care Access in VA Primary Care-Mental Health Integration. J Prim Care Community Health 2022; 13:21501319221091430. [PMID: 35426344 PMCID: PMC9016585 DOI: 10.1177/21501319221091430] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Same-day referrals from primary care to mental health increase subsequent
mental health treatment engagement. VA Primary Care-Mental Health
Integration (PC-MHI) clinics offer integrated mental health services
embedded in primary care clinics, providing a key entry point to mental
health care. Although telehealth use expanded rapidly after the onset of
COVID-19, the impact of telehealth on same-day primary care access among new
PC-MHI mental health patients is unknown. To address this knowledge gap, we
examined associations between telehealth use and same-day primary care
access in VA PC-MHI. Methods: We examined electronic health record data to identify same-day primary care
appointments among PC-MHI patients who initiated care during 3/1/2018 to
10/29/2021. We used logistic regression analyses to evaluate the effect of
telehealth on same-day primary care access. Time, demographic
characteristics, mental health diagnoses (PTSD and depression), and
substance use disorder diagnosis were evaluated as covariates. Results: New PC-MHI patients who were seen via telehealth were less likely to receive
same-day primary care access than patients seen in person (OR: 0.54; 95% CI:
0.41-0.71; P < .001). Conclusions: Despite the potential advantages of using telehealth to increase access, VA
patients with an initial PC-MHI visit via telehealth were less likely than
patients seen in person to be referred from primary care. Telehealth may
adversely affect primary care referrals to mental health services, an
outcome that could ultimately reduce specialty mental health care
continuity. There is an urgent need to identify strategies to facilitate
PC-MHI care coordination in the telehealth context.
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Affiliation(s)
- Taona P Haderlein
- U.S. Department of Veterans Affairs, North Hills, CA, USA.,Greater Los Angeles VA Medical Center, Los Angeles, CA, USA
| | - Aram Dobalian
- U.S. Department of Veterans Affairs, North Hills, CA, USA.,The Ohio State University, Columbus, OH, USA
| | - Pushpa V Raja
- Greater Los Angeles VA Medical Center, Los Angeles, CA, USA
| | - Claudia Der-Martirosian
- U.S. Department of Veterans Affairs, North Hills, CA, USA.,Greater Los Angeles VA Medical Center, Los Angeles, CA, USA
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12
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Wong MS, Yuan AH, Haderlein TP, Jones KT, Washington DL. Variations by race/ethnicity and time in Covid-19 testing among Veterans Health Administration users with COVID-19 symptoms or exposure. Prev Med Rep 2021; 24:101503. [PMID: 34312589 PMCID: PMC8295495 DOI: 10.1016/j.pmedr.2021.101503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/10/2021] [Accepted: 07/18/2021] [Indexed: 12/19/2022] Open
Abstract
Racial/ethnic disparities in coronavirus disease 2019 (COVID-19) hospitalization and mortality have emerged in the United States, but less is known about whether similar differences exist in testing, and how this changed as COVID-19 knowledge and policies evolved. We examined racial/ethnic variations in COVID-19 testing over time among veterans who sought care for COVID-19 symptoms or exposure. In the national population of all Veterans who sought Veterans Health Administration (VHA) care for COVID-19 symptoms or exposure (n = 913,806), we conducted multivariate logistic regressions to explore race/ethnicity-by-time period differences in testing from 3/1/2020-11/25/2020, and calculated predicted probabilities by race/ethnicity and time period. Early in the pandemic (3/1/2020-4/6/2020) when testing was limited and there was less awareness of racial/ethnic disparities, non-Hispanic Black, Hispanic, and other non-White racial/ethnic minority Veterans who sought care from VHA for COVID-19 symptoms or exposure were more likely than non-Hispanic White Veterans to receive a COVID-19 test (p < 0.05). In subsequent time periods (4/7/2020-11/25/2020), testing was similar among all racial/ethnic groups. Among Veterans with COVID-19 symptoms or exposure, non-Hispanic Black and Hispanic patients were just as likely, and in some cases, more likely, to receive a COVID-19 test versus non-Hispanic White patients. The United States faced testing shortages at the start of the third wave of the pandemic; additional shortages are likely to emerge as the pandemic continues to peak and ebb. It is important to ensure that racial/ethnic minorities and others at greater risk for infection continue to have access to COVID-19 testing with each of these peaks.
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Affiliation(s)
- Michelle S. Wong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States
| | - Anita H. Yuan
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States
| | - Taona P. Haderlein
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States
| | - Kenneth T. Jones
- VHA Office of Health Equity, 810 Vermont Ave, NW, Washington, DC 20420, United States
| | - Donna L. Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles Geffen School of Medicine, 1100 Glendon Ave, Suite 850, Los Angeles, CA 90024, United States
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13
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Haderlein TP, Tomiyama AJ. Effects of internet-delivered eating disorder prevention on reward-based eating drive: A randomized controlled trial. Eat Behav 2021; 43:101572. [PMID: 34626891 DOI: 10.1016/j.eatbeh.2021.101572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/17/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study is a secondary analysis testing the effects of an internet eating disorder prevention program on reward-based eating drive in a high-risk sample of college-aged women. METHOD We analyzed data from 278 women who were randomized to internet dissonance-based intervention (DBI-I), internet cognitive-behavioral treatment (CBTI), or no intervention (NI). Both active conditions consisted of self-guided activities completed over the course of four weeks. Linear mixed effects modeling was used to test the effect of internet intervention on reward-based eating drive. RESULTS DBI-I was associated with greater reductions in reward-based eating over time than NI. No other Condition × Time effects were found. DISCUSSION The results provide preliminary support for DBI-I as a strategy for reducing reward-based eating drive in a high-risk population relative to no intervention.
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Affiliation(s)
- Taona P Haderlein
- VA Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation, and Policy, United States of America.
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14
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Haderlein TP, Wong MS, Yuan A, Llorente MD, Washington DL. Association of PTSD with COVID-19 testing and infection in the Veterans Health Administration. J Psychiatr Res 2021; 143:504-507. [PMID: 33261820 PMCID: PMC7682935 DOI: 10.1016/j.jpsychires.2020.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/15/2020] [Accepted: 11/18/2020] [Indexed: 12/16/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with coronavirus disease 2019 (COVID-19) risk factors, such as hypertension and obesity. Associations between PTSD and COVID-19 outcomes may affect Veterans Health Administration (VA) services, as PTSD occurs at higher rates among veterans than the general population. While previous research has identified the potential for increased PTSD prevalence resulting from COVID-19 as a public health concern, no known research examines the effect of pre-existing PTSD on COVID-19 test-seeking behavior or infection. This study aimed to evaluate pre-existing PTSD as a predictor of COVID-19 testing and test positivity. The sample consisted of 6,721,407 veterans who sought VA care between March 1, 2018 and February 29, 2020. Veterans with a previous PTSD clinical diagnosis were more likely to receive COVID-19 testing than veterans without PTSD. However, among those with available COVID-19 test results (n = 168,032), veterans with a previous PTSD clinical diagnosis were less likely to test positive than veterans without PTSD. Elevated COVID-19 testing rates among veterans with PTSD may reflect increased COVID-19 health concerns and/or hypervigilance. Lower rates of COVID-19 test positivity among veterans with PTSD may reflect increased social isolation, or overrepresentation in the tested population due to higher overall use of VA services. As the COVID-19 pandemic continues, the identification of patient-level psychiatric predictors of testing and test positivity can facilitate the targeted provision of medical and mental health services to individuals in need.
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Affiliation(s)
- Taona P. Haderlein
- VA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Michelle S. Wong
- VA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Anita Yuan
- VA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Maria D. Llorente
- Department of Veterans Affairs, Patient Care Services, Washington, DC, USA,Georgetown University School of Medicine, Department of Psychiatry, Washington, DC, USA
| | - Donna L. Washington
- VA HSR&D Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA,Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA,Corresponding author. 11301 Wilshire Blvd, 111G, Los Angeles, CA, 90073, USA
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15
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Breland JY, Wong MS, Steers WN, Yuan AH, Haderlein TP, Washington DL. BMI and Risk for Severe COVID-19 Among Veterans Health Administration Patients. Obesity (Silver Spring) 2021; 29:825-828. [PMID: 33403755 DOI: 10.1002/oby.23121] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/25/2020] [Accepted: 12/22/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study was to assess associations between BMI and severe coronavirus disease 2019 (COVID-19) outcomes: hospitalization, intensive care unit (ICU) admission, and mortality. A secondary aim was to investigate whether associations varied by age. METHODS The cohort comprised patients in the Veterans Health Administration (VHA) who tested positive for COVID-19 (N = 9,347). For each outcome, we fit piecewise logistic regression models with restricted cubic splines (knots at BMI of 23, 30, and 39), adjusting for age, sex, comorbidities, VHA nursing home residence, and race/ethnicity. Supplemental analyses included age-by-BMI interaction terms (α = 0.05). RESULTS We found evidence of a nonlinear J-curve association between BMI and likelihood of hospitalization and mortality. BMI was associated with increased odds for hospitalization, ICU admission, and mortality among patients with BMI 30 to 39 but decreased odds of hospitalization and mortality for patients with BMI 23 to 30. Patients under age 75 with BMI between 30 and 39 had increased odds for mortality with increasing BMI. CONCLUSIONS Odds for severe outcomes with COVID-19 infection increased with increasing BMI for people with, but not without, obesity. This nonlinear relationship should be tested in future research. COVID-19 public health messages in VHA, and broadly, should incorporate information about risks associated with all classes of obesity, particularly for those under age 75.
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Affiliation(s)
- Jessica Y Breland
- VA Health Services Research and Development Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Michelle S Wong
- VA Health Services Research and Development Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - W Neil Steers
- VA Health Services Research and Development Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Anita H Yuan
- VA Health Services Research and Development Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Taona P Haderlein
- VA Health Services Research and Development Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Donna L Washington
- VA Health Services Research and Development Center for the Study of Health Care Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
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16
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Wong MS, Haderlein TP, Yuan AH, Moy E, Jones KT, Washington DL. Time Trends in Racial/Ethnic Differences in COVID-19 Infection and Mortality. Int J Environ Res Public Health 2021; 18:4848. [PMID: 34062806 PMCID: PMC8124342 DOI: 10.3390/ijerph18094848] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 11/20/2022]
Abstract
Studies documenting coronavirus disease 2019 (COVID-19) racial/ethnic disparities in the United States were limited to data from the initial few months of the pandemic, did not account for changes over time, and focused primarily on Black and Hispanic minority groups. To fill these gaps, we examined time trends in racial/ethnic disparities in COVID-19 infection and mortality. We used the Veteran Health Administration's (VHA) national database of veteran COVID-19 infections over three time periods: 3/1/2020-5/31/2020 (spring); 6/1/2020-8/31/2020 (summer); and 9/1/2020-11/25/2020 (fall). We calculated COVID-19 infection and mortality predicted probabilities from logistic regression models that included time period-by-race/ethnicity interaction terms, and controlled for age, gender, and prior diagnosis of CDC risk factors. Racial/ethnic groups at higher risk for COVID-19 infection and mortality changed over time. American Indian/Alaskan Natives (AI/AN), Blacks, Hispanics, and Native Hawaiians/Other Pacific Islanders experienced higher COVID-19 infections compared to Whites during the summertime. There were mortality disparities for Blacks in springtime, and AI/ANs, Asians, and Hispanics in summertime. Policy makers should consider the dynamic nature of racial/ethnic disparities as the pandemic evolves, and potential effects of risk mitigation and other (e.g., economic) policies on these disparities. Researchers should consider how trends in disparities change over time in other samples.
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Affiliation(s)
- Michelle S. Wong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System 11301 Wilshire Blvd, Los Angeles, CA 90073, USA; (T.P.H.); (A.H.Y.); (D.L.W.)
| | - Taona P. Haderlein
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System 11301 Wilshire Blvd, Los Angeles, CA 90073, USA; (T.P.H.); (A.H.Y.); (D.L.W.)
| | - Anita H. Yuan
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System 11301 Wilshire Blvd, Los Angeles, CA 90073, USA; (T.P.H.); (A.H.Y.); (D.L.W.)
| | - Ernest Moy
- VHA Office of Health Equity, 810 Vermont Ave NW, Washington, DC 20420, USA; (E.M.); (K.T.J.)
| | - Kenneth T. Jones
- VHA Office of Health Equity, 810 Vermont Ave NW, Washington, DC 20420, USA; (E.M.); (K.T.J.)
| | - Donna L. Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System 11301 Wilshire Blvd, Los Angeles, CA 90073, USA; (T.P.H.); (A.H.Y.); (D.L.W.)
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles Geffen School of Medicine, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA
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