Factors Associated with Long COVID Care Documentation among VA Patients

BACKGROUND:
The World Health Organization developed a definition of post-COVID-19 condition (also referred to as long COVID) based on certain symptoms or impairments that cannot be explained by an alternative diagnosis at least three months after the onset of infection. As many as 33 post-acute sequelae of COVID-19 infection have been identified, including pulmonary, cardiovascular, and mental health disorders. However, there is limited information about which patients seek care for potential manifestations of long COVID and the extent to which practitioners document that care as management of long COVID. This retrospective cohort study examined the rates, clinical setting, and factors associated with documented receipt of COVID-19-related care three or more months after acute infection. Investigators identified 198,601 survivors of acute COVID-19 infection, who had been diagnosed in VA with a positive COVID test between February 1, 2020 and April 30, 2021. The primary outcome was documentation in VA’s electronic health record of any of four COVID-19-related ICD-10 codes in one or more VA encounters three or more months after the date of infection through December 31, 2021. Investigators also assessed sociodemographic, geographic, and clinical characteristics as well as vaccination status.

FINDINGS:

• In this cohort, long COVID care was documented in 26,745 Veterans (14%). Factors significantly associated with long COVID care included: older age, Black or American Indian/Alaska Native race, Hispanic ethnicity, geographic region, multiple comorbidities, having documented symptoms at the time of acute infection, and requiring hospitalization or mechanical ventilation.
• Veterans who had received both doses of mRNA vaccine at the time of COVID-19 infection (considered fully vaccinated) were less likely to have received care for long COVID.
• There was significant variability in rates of long COVID care documentation across VISNs (11%-18%) and VAMCs (3%-41%); 16 VA facilities with dedicated clinics for long COVID follow-up had higher rates.
• The most common outpatient clinics at which Veterans with long COVID presented were primary care and general internal medicine (33% of encounters).

IMPLICATIONS:

• Findings should provide support and guidance for healthcare systems to develop approaches to the evaluation and management of patients who experience long COVID.

LIMITATIONS:

• It is unclear what symptoms or manifestations might have prompted physicians to document a COVID-19-related ICD-10 code more than three months after the onset of infection.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (C19 21-279). Dr. Ioannou is part of HSR&D’s Denver/Seattle Center of Innovation for Veteran-Centered & Value-Driven Care.

Ioannou G, Baraff A, Fox A, et al. Rates and Factors Associated with Documentation of Diagnostic Codes for Long COVID in the National Veterans Affairs Health Care System. JAMA Network Open. July 29, 2022; 5(7):e2224359.