Abstract

Significance to VA: Extreme heat events (EHEs) are the deadliest weather-related causes of death in the US and are becoming more frequent as global average temperatures rise. In an analysis I performed of California homeless-experienced Veterans (HEVs) with cardiometabolic disease, EHEs were significantly associated with mortality (odds ratio 1.36 for same-day EHEs). To reduce EHE-associated morbidity and mortality, national public health agencies recommend that healthcare systems develop plans that include preventive services. However, a heat-preparation plan or intervention currently does not exist in VA primary care. Given the increased frequency of EHEs, the VA must develop and implement heat-preparation interventions in routine care settings that provide preventive social and medical services for HEVs, namely Homeless Patient Aligned Care Team (HPACT) clinics. I propose to develop and pilot test a heat-preparation intervention tailored to the specific needs of HPACT patients and staff. Findings from this proposal will facilitate the uptake of an HPACT- embedded heat-preparation intervention across VA facilities adapted to local organizational contexts. This research aligns with the HSR topic area of behavioral, social and cultural determinants of health. Innovation and Impact: This research is among the first in the HSR research portfolio that pertains to the growing threat of a warming climate on high-risk/high-need Veterans. It is among the first projects within or outside VA that studies the implementation and impact of a primary care-based heat-preparation intervention to mitigate risk of adverse outcomes from extreme heat. It is also among the first research projects that engages HEVs to assess resources needed during EHEs. The intervention could mitigate the risk of adverse outcomes among HEVs and save lives during EHEs, thus responding to the goal of improving outcomes within VA’s Quintuple Aim. The intervention could be tested with other high-risk/high-need populations within as well as outside VA and could be adapted to respond to other weather-related phenomena. Specific Aims: I aim to: Aim 1: Develop an HPACT-embedded heat-preparation intervention, the Nurturing Veterans Resilience to Heat Overexposure Toolkit (NVR-HOT); Aim 2: Evaluate the acceptability and feasibility of NVR-HOT in a single-arm pilot study, and develop processes for measuring effectiveness, which will be used in future effectiveness trials; and Aim 3: Evaluate barriers and facilitators of implementation of NVR-HOT in the context of the pilot study. Methodology: In Aim 1a, I will conduct semi-structured interviews with key informants (i.e., HEVs, HPACT clinicians and staff, HPACT and VA homeless services leaders, and experts in heat and health) to bring together diverse perspectives on core elements of NVR-HOT informed by existing literature. In Aim 1b, I will conduct a modified Delphi panel to identify areas of consensus among HEVs, HPACT and VA homeless services leaders to finalize NVR-HOT. In Aim 2, I will conduct a single-arm pilot trial of NVR-HOT at VA Greater Los Angeles HPACT and a) conduct surveys and semi-structured interviews with HEVs and HPACT clinicians and staff who participated in the pilot study to measure the acceptability and feasibility of NVR-HOT and b) use administrative data to abstract measures of effectiveness (e.g., emergency department visits for heat-related illness) and key covariates. In Aim 3, I will conduct semi-structured interviews with key informants who participated in the pilot trial to measure barriers and facilitators of implementing NVR-HOT into routine care. Path to Translation/Implementation: In CDA Year 3, I will submit an IIR to examine multilevel factors that contribute to adverse outcomes (including utilization and mortality) for HEVs during EHEs. In Year 5, I will submit an IIR for a multi-site implementation-effectiveness cluster-randomized trial that investigates the impact of NVR-HOT on outcomes during EHEs and identifies barriers and facilitators to its integration into routine care settings. Findings will be shared with key national and local partners to inform future implementation.

NIH Reporter Project Information: https://reporter.nih.gov/project-details/11341067


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