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2023 HSR&D/QUERI National Conference Abstract

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1167 — Exploring Best Practices for Completing Airborne Hazards and Open Burn Pits Registry (AHOBPR) Exams

Lead/Presenter: Trenton M. Haltom,  COIN - Houston
All Authors: Haltom TM (Center for Innovations in Quality, Effectiveness and Safety [IQuESt]; Baylor College of Medicine), Chen P (Center for Innovations in Quality, Effectiveness and Safety [IQuESt]; Baylor College of Medicine), Zhou T (Center for Innovations in Quality, Effectiveness and Safety [IQuESt]; University of Houston), Azebe-Osime I (Center for Innovations in Quality, Effectiveness and Safety [IQuESt]; Baylor College of Medicine), Han J (Center for Innovations in Quality, Effectiveness and Safety [IQuESt]; Baylor College of Medicine), Wallin WB (Center for Innovations in Quality, Effectiveness and Safety [IQuESt]; MEDVAMC), Christie I (Center for Innovations in Quality, Effectiveness and Safety [IQuESt]; Baylor College of Medicine), Godwin K (Center for Innovations in Quality, Effectiveness and Safety [IQuESt]; Baylor College of Medicine), and Helmer DA (Center for Innovations in Quality, Effectiveness and Safety [IQuESt]; Baylor College of Medicine; Michael E. DeBakey VA Medical Center).

Objectives:
The goals of the Airborne Hazards and Open Burn Pits Registry (AHOBPR) are to address Veteran concerns of possible airborne exposure to toxic substances (e.g., burn pit smoke) and to generate data to facilitate research. The AHOBPR was mandated by Congress in 2013 (Public Law 112-260, 2013), yet AHOBPR exams have only become a priority for the VHA under recent public, VA Office of Inspector General (VA OIG), and Congressional pressures. As of May 2022, only 21.4% of Veterans who requested an exam on the AHOBPR have received one according to their VHA medical records. Our goal was to gather firsthand accounts of how high-performing VA sites around the U.S. were successfully completing AHOBPR exams and produce an aggregate “best practices” guide to aid implementation at other sites.

Methods:
Qualitative, in-depth interviews elicited information about facility processes for conducting AHOBPR exams, the strengths/weaknesses of these processes, challenges, and recommendations for success. We interviewed clinicians and coordinators who conduct AHOBPR exams at 10 VA locations across the U.S. between June and September 2021. Interviews were conducted remotely via teleconferencing platform and analyzed using rapid analysis.

Results:
Findings across sites related to administrators, clinical structures, and exam itself. We find that having strong, supported administrative personnel effectively coordinate AHBOPR exam activities. Indeed, administrators should have a clear understanding of how to navigate and track patients in the Veterans Integrated Registries Platform (VIRP). Participants also would help Veterans complete the AHOBPR, check Veteran eligibility for other environmental hazards exams, and share information about the AHOBPR. Most sites have a dedicated “Clinical Champion” who conducts the exams and who has expertise in exposure concerns. On average, exams lasted an hour and were typically conducted via telehealth. Finally, participants recommended some best practices including coordinating with other departments at the facility, using patient portals for communication, and facilitating multi-pronged outreach strategies. Overall, participants noted the importance of communication and compensation for all AHOBPR exam facilitators.

Implications:
Our findings demonstrate the processes for conducting AHBPR exams and produce guidelines for successfully completing AHOBPR exams for interested Veterans at other VA locations.

Impacts:
Our best practices guide is useful to sites new to performing AHOBPR Exams. AHOBPR exams are care only the VA can provide and a gateway for recent combat Veterans to enroll in the VA. When conducted appropriately, AHOBPR exams can be a mechanism for enhancing satisfaction and retention within VA health care.