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Researchers from the HSR&D Evidence Synthesis Program are working to help synthesize publications about the novel coronavirus and COVID-19, and to translate that information quickly into usable guidance for clinicians. The ESP’s completed reports can be found here.
Additional evidence reviews can be found at www.covid19reviews.org. The goal of this resource is to capture the work of evidence synthesis groups, like VA’s, around the US and the globe, and thereby avoid duplication of effort and maximize the contribution of these researchers. The catalog is maintained by the VA ESP Coordinating Center in Portland, Oregon. New evidence reviews and reviews in progress are identified through literature searching and correspondence with colleagues and content experts. The team has also set up a listserv to facilitate collaboration among systematic review researchers.
HSR&D Rapid Response Projects
Under a Rapid Response RFA (Spring 2020), HSR&D funded a set of 9-month projects to investigate and address impacts of the COVID-19 pandemic and response on clinical care and delivery, patient and provider outcomes, and the VA healthcare system. These rapid response projects are intended to jumpstart research efforts and lay the groundwork for longer-term studies. View project list
Collaboratory on Observational Research in COVID (CORC)
HSR&D will be funding a multi-site team, led by Drs. George Ioannou (Puget Sound) and Jack Iwashyna (Ann Arbor), to lead the COVID-19 Observational Research Collaboratory (CORC). CORC will conduct a VHA-wide observational study focused on long-term recovery from COVID-19. In addition, this group will run a coordinating center that will provide methodological guidance to the field regarding best practices for the conduct of observational COVID-19 research and work with VINCI to develop tools to meet the data needs of investigators carrying out observational COVID-19 research.
Medication Collaboratory and Long Term Outcomes
VA’s Medication Safety and Effectiveness Collaboratory brings together VA experts to analyze the use and effects of drugs with clinical partners interested in the safety and effectiveness of COVID-19 therapies. Led by HSR&D, and with collaboration from VA’s Clinical Science Research and Development Service, the goal of the collaboratory is to improve approaches to using VA data by getting input from a range of experts in pharmaco-epidemiology—the long-term study of medications—and data methods. Below are the HSR&D-funded studies that make up part of the collaboratory’s body of research. View project list
Health equity and COVID
The pandemic has provided yet another stark example of the disproportionate disease burden experienced by racial and ethnic minority communities in the United States. To date, two large retrospective cohort studies (Ioannou et al., 2020; Rentsch et al., 2020) have investigated racial and ethnic disparities in COVID-19 incidence and outcomes among patients receiving VA care. Rentsch and colleagues found that Black and Hispanic Veterans were more likely to test positive for COVID-19 than non-Hispanic White Veterans. However, among patients with COVID-19, they found no difference in 30-day mortality by race or ethnicity. Ioannou and colleagues likewise found no difference in case fatality rate by race or ethnicity, but they did find that Black Veterans with COVID-19 required mechanical ventilation at higher rates than their White counterparts. These data are largely consistent with comparable studies from outside of the VA (Mackey et al., 2020) and suggest that the main driver of racial and ethnic disparities in rates of COVID-19 infection, hospitalization, and mortality is exposure (e.g., status as a frontline worker).
Ioannou GN, Locke E, Green P, Berry K, O'Hare AM, Shah JA, Crothers K, Eastment MC, Dominitz JA, Fan VS. (2020). Risk Factors for Hospitilazation, Mechanical Ventilation, or Death Among 10,131 US Veterans With SARS-CoV-2 Infection. JAMA Netw Open, September 1, 2020.
Mackey K, Ayers CK, Kondo KK, Saha S, Advani SM, Young S, Spencer H, Rusek M, Anderson J, Veazie S, Smith M, Kansagara D. (2020). Racial and Ethnic Disparities in COVID-19-Related Infections, Hospitalizations, and Deaths: A Systematic Review. Ann Intern Med, December 1, 2020.
Rentsch CT, Kidwai-Khan F, Tate JP, Park LS, King JT, Skanderson M, Hauser RG, Schultze A, Jarvis CI, Holodniy M, Lo Re V, Akgun KM, Crothers K, Taddei TH, Freiberg MS, Justice AC. (2020). Patterns of COVID-19 testing and mortality by race and ethnicity among United States veterans: a nationwide cohort study. PLoS Med, September 22, 2020.
Impacts of deferred and disrupted care during COVID pandemic
Impacts of deferred and disrupted care during COVID pandemic
HSR&D has announced funding opportunities for research examining the possible connection(s) between pandemic-related disruptions in care and social support and possible increases in Veteran mortality and morbidity across chronic, acute, and mental health care settings. The first solicitation is for a Disrupted Care Coordinating Center to (1) conduct a high-level national study of changes in all-cause mortality; (2) direct a data and methods work group to identify data needs and promote use of common measures of pandemic impact, disrupted care, and disease outcomes; and (3) provide partner coordination and communications leadership across individual studies to ensure alignment with other VA efforts and Federal initiatives. The second solicitation is a service-directed RFA (released for and reviewed at the 2021 August SMRB) to support research that examines if and how pandemic-related disruptions to care and to social supports have affected VHA health care delivery, the nature and quality of services received, and Veteran health outcomes. Please refer to the funding page for details on both.
Modeling of COVID outcomes
The COVID data modeling workgroup is a venue for ORD investigators to collaborate on modeling the risk of infection and poor outcomes among Veterans (in general and among those who receive care at the VA). The workgroup discusses optimal use cases for modeling to improve clinical decisions and care; creates opportunities for cross-project collaboration; discusses requirements for developing, adapting, and applying and evaluating models in clinical practice; and shares lessons learned. Additional details are available in this presentation.
Research on vaccination implementation
QUERI is leading Rapid Response teams to create and conduct surveys of both Veterans and VHA workers' attitudes toward COVID-19 vaccinations, examine the implementation of the vaccines at sites, and sharing lessons learned.
In addition, HSR&D has initiated a research effort to conduct qualitative and quantitative assessments of facilitators and barriers to Veterans' COVID vaccine uptake, develop multi-faceted interventions addressing health disparities in the vaccine uptake, assess effectiveness of clinician-led coaching/education intervention, and coordinate efforts with the National Center for Health Promotion and Disease Prevention (NCP), other VHA stakeholders, and federal partners (e.g., NIH and CDC). For additional details, see: https://www.hsrd.research.va.gov/funding/COVID-vaccine-behavior-study-RFA.pdf.