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C19 20-208 – HSR&D Study

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C19 20-208
Identify and develop methods for monitoring the sequelae of COVID-19 disease and treatment
Denise M. Hynes PhD MPH BSN
Portland, OR
Funding Period: May 2020 - March 2021

BACKGROUND/RATIONALE:
While much attention is appropriately focused on the acute phase of minimizing further spread of the COVID-19 virus, protecting frontline clinicians, and treatment of those who contract the illness, it is also important to plan for surveillance and monitoring sequelae of COVID-19 illness and treatment. Recent clinical reports have revealed that COVID-19 disease is associated with a high inflammatory response that can result in viral pneumonia, cardiac and neurological symptoms, and complications. The severity, extent, and short-term versus long-term respiratory, cardiovascular, and neurological effects of COVID-19, along with the effect of specific COVID-19 treatments (e.g. steroids, unlabeled drug use, new drugs and therapies, etc.) are not yet known. Additional concerns remain about the long-term mental health impacts on those who recover, especially among those with pre-existing mental health conditions. Severity of symptoms and mortality have been highest among the elderly, males, and those with comorbidities including chronic lung disease, hypertension, diabetes mellitus, cardiovascular diseases, and cerebrovascular diseases. The health impacts on vulnerable populations are also coming to light.
Among the Veteran population, the VA had tracked 2,184 positive COVID 19 cases as of April 4, 2020 (VA Public Health website: https://www.publichealth.va.gov/n-coronavirus/). The largest volume was is in New York and New Orleans. Data are dynamic due to the rapid rise in cases, especially in more urban sites. With knowledge that Veterans in the VA tend to have more comorbidities compared to the general population, for those who contract COVID-19 and ultimately recover, they may experience exacerbation of preexisting respiratory, cardiac, and mental health conditions, as well as develop new conditions.

OBJECTIVE(S):
During the nine-month planning study we will:
1) Identify VA primary care patients who were treated for COVID-19 at three VA sites facing significant surges using available data in the VA national data sets i.e. Corporate Data Warehouse (CDW), VA Inpatient Evaluation Center (IPEC) data, VA Community Care claims (e.g., health factors, vital signs, lab tests, ICU admissions, diagnosis coding and treatment regimens; etc.) with input from a Clinical and Epidemiology Advisory Committee;
2) Among Veterans treated for COVID-19, describe the patient-level health impacts through December 2020, including hospital readmissions, exacerbation of existing conditions, development of new COVID-related chronic conditions, and vital status; and
3) Among Veterans treated for COVID-19, explore and examine factors (e.g., ICU treatment or not, medications, comorbidities, urban residence, medications used during acute and recovery phase) associated with patient outcomes (readmissions, new-related conditions, mental health status, mortality) during the first six to nine months after diagnosis.

METHODS:
We will identify and develop methods for monitoring the sequelae of COVID-19 disease and treatment. With input from clinical and epidemiology experts, we will leverage an existing data set of VA primary care patients from our ongoing research project to identify and examine the impact of COVID-19 illness on Veterans. It includes over 7.6 million new and continuing VA patients nationally since 2015 and current through 2019, with updates as data become available. Using this database, we will track VA patients treated for COVID-19 at a subset of VA facilities that faced significant surges (e.g. New York, New Orleans, etc.) in early FY20 and follow their trajectory through December 2020. We will work with VA COVID-19 VA leaders to select the specific VA sites.
The Clinical & Epidemiology Advisory Committee (CEAC) will be convened virtually for three meetings during the nine-month project. The CEAC will review the study team's initial criteria for identifying COVID-19 cases, and criteria for identifying and classifying subsequent health conditions, and review preliminary analyses. These meetings will also assist in identifying information gaps that may require new routinely collected data (e.g. ventilator days) or new patient reported data (symptoms after recovery) that could be a focus in a subsequent study.
Analyses will be primarily descriptive (frequencies, means) and include regression analysis to explore patient's predisposing, enabling, clinical need, and geographic factors associated with each outcome.

FINDINGS/RESULTS:
Pending

IMPACT:
This work is foundational to ensure a coordinated approach to planning for Veterans long term health outcomes related to COVID-19. Understanding the longer-term health impacts on Veterans will better position the VA and public health authorities to address their future health needs.

PUBLICATIONS:
None at this time.

DRA: None at this time.
DRE: None at this time.
Keywords: None at this time.
MeSH Terms: None at this time.

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