Disrupted Care National Project

What is the Disrupted Care National Project?

In summer 2021, HSR&D initiated funding for a Disrupted Care National Project (DCNP), based at the White River Junction VA Medical Center with additional sites at West Haven and Palo Alto. The aim of the DCNP is to better understand the disruptions in care during the pandemic so that VA can learn what could have been done differently, to prevent similar disruptions in the future, and to inform the recovery from the pandemic.

This project has two parts: a research collaboration to map and analyze the causes of excess mortality within the VA health system during the pandemic, and a Disrupted Care National Coordinating Center. The Coordinating Center is fostering the community of VA investigators working on Disrupted Care by creating a “Big Tent” of investigators working in this area with the aim of accelerating progress through the sharing of research methods and results.

Analytic Aims of the DCNP

1. Using an ecological approach, compare pre and pandemic mortality documented in VA, CDC, and Medicare data with and without known COVID-19 deaths overall, by month, and by demographic subgroups.
2. Using an ecological approach, compare pre and pandemic health care utilization in VA and Medicare data with and without known COVID-19 cases; study associations between changes in utilization and mortality overall, by month, and by demographic subgroups.
3. Using an in-depth patient-level approach with VA EHR data, estimate the hazard ratios for pre and pandemic mortality with and without known COVID-19 cases.

DCNP Coordinating Center Aims

1. Accelerate progress in the disrupted care agenda through coordination of the work.
2. Create a community of research, building connections between researchers to accelerate the efficiency and impact of the work funded by HSR&D.
3. Provide a forum for discussion and curation of data metrics, methodologies, and data sources.

The DCNP Team Leadership

The project is led by Louise Davies, MD, MS (Corresponding PI, White River Junction VAMC), Amy Justice, MD, PhD (mPI, VA Connecticut HCS – West Haven), and Anita Vashi, MD, MPH, MHS (mPI, VA Palo Alto HCS).

Lead statisticians include Caroline Korves, ScD (White River Junction VAMC), Christopher Rentsch, PhD, MPH (VA Connecticut HCS – West Haven), and Daniel Weinberger, PhD (Yale School of Public Health).

The DCNP team also includes the following investigators across the three study sites

• White River Junction VAMC
  • Jesse Columbo, MD, MS
  • Philip Goodney, MD, MS
  • Brian Lucas, MD

• VA Connecticut HCS – West Haven
  • Joseph T. King Jr., MD, MSCE, FAANS

• VA Palo Alto HCS
  • Steven Asch, MD, MPH
  • Linda Diem Tran, PhD, MPP
  • Todd Wagner, PhD

The DCNP Steering Committee includes HSR&D leadership, members of the VA COVID-19 Observational Research Collaboratory (CORC) and the Partnered Evidence-Based Policy Resource Center (PEPReC), representatives from VA program offices including Surgical Services, Primary Care, Quality, Mental Health, Health Equity, and Pharmacy Benefits. In addition, the committee includes VA current and retired clinical staff.

Louise Davis, MD, MS

Amy Justice, MD, PhD

Anita Vashi, MD, MPH, MHS

DCNP team meeting, Dartmouth, New Hampshire, November 2022 Contact Us Please email Samuel Rosa, DCNP Project Manager, with any questions related to the Disrupted Care National Project.

DCNP team hike in Vermont, November 2022

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