1162 — Addressing delayed care due to COVID-19: Use of the Preventive Health Inventory in Veteran’s Health Administration’s Primary Care

Lead/Presenter: Chelle Wheat,  Primary Care Analytics Team
All Authors: Wheat CL (Primary Care Analytics Team [PCAT], Seattle), Gunnink EJ (Primary Care Analytics Team [PCAT], Seattle) Rojas J (Primary Care Analytics Team [PCAT], Seattle) Nelson KM (Primary Care Analytics Team [PCAT], Seattle) Wong ES (Seattle/Denver COIN) Gray KE (Seattle/Denver COIN) Stockdale SE (Veterans Assessment & Improvement Laboratory [VAIL], Los Angeles) Rosland AM (VA Center for Health Equity Research and Promotion [CHERP], Pittsburgh) Chang ET (Center for the Study of Healthcare Innovation, Implementation and Policy [CSHIIP], Los Angeles) Reddy AS (Primary Care Analytics Team [PCAT], Seattle)

Objectives:
In February 2021, Veterans Health Administration (VHA) launched the Preventive Health Inventory (PHI), a multi-component care management intervention to support primary care delivery of chronic and preventive care disrupted by the COVID-19 pandemic. Components included a national dashboard of quality measures, a proactive virtual nurse visit, and a templated electronic health record note to complete chronic and preventive care. We assessed key factors associated with PHI uptake and changes in quality of care.

Methods:
Among 1,020 VHA primary clinics, we identified clinics with high and low PHI use (top/bottom 10%) measured by the number of completed nurse visits using the templated notes through 1-year post-implementation. To identify factors associated with high PHI adoption, we descriptively compared patient, provider, and clinic factors between high and low clinics. To identify impacts of the PHI on quality, we applied interrupted time series models to estimate changes in diabetes and hypertension measures from February 2020 through February 2022. We stratified analyses by high and low PHI use.

Results:
Among 6 million Veterans enrolled in primary care, 290,144 had the PHI completed. High PHI clinics completed an average of 32,997/100,000 notes compared to 57/100,000 at low PHI clinics. Clinics with high PHI use had more racial and ethnic diversity (15.0% vs. 4.7% Non-Hispanic Black and 14% vs. 3.5% Hispanic Veterans, respectively), were larger (mean: 12,072 vs. 5,713 patients) and located in more urban areas (91% vs 57% urban). Staffing did not differ meaningfully between low and high PHI use clinics (3.41 vs. 3.39). The estimated impact of the PHI was approximately 3,350 per 100,000 fewer Veterans having an HbA1c greater than 9 or missing (6,578/100,000 at low and 9,928/100,000 at high) and 4,874 per 100,000 more Veterans having their annual HbA1c measured at high use clinics compared to low use clinics (8,307/100,000 at low and 13,181/100,000 at high). Additionally, 8,306 per 100,000 more Veterans had adequate control of their blood pressure compared to low use sites (12,276/100,000 at low and 20,582/100,000 at high).

Implications:
We found higher PHI uptake at larger, urban clinics with more racial/ethnic diversity. Quality improved more at high PHI use sites compared to low use sites.

Impacts:
These findings demonstrate that a proactive care management intervention in primary care can improve the quality of chronic disease care disrupted by a pandemic.