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Schildhouse RJ, Gupta A, Greene MT, Fowler KE, Ratz D, Hausman MS, Saint S. Comparison of the Impact of COVID-19 on Veterans Affairs and Non-federal Hospitals: a Survey of Infection Prevention Specialists. J Gen Intern Med 2023; 38:450-455. [PMID: 36451008 PMCID: PMC9713132 DOI: 10.1007/s11606-022-07961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND As the COVID-19 pandemic evolves, it is critical to understand characteristics that have allowed US healthcare systems, including the Veterans Affairs (VA) and non-federal hospitals, to mount an effective response in the setting of limited resources and unpredictable clinical demands generated by this system shock. OBJECTIVE To compare the impact of and response to resource shortages to both VA and non-federal healthcare systems during the COVID-19 pandemic. DESIGN Cross-sectional national survey administered April 2021 through May 2022. PARTICIPANTS Lead infection preventionists from VA and non-federal hospitals across the US. MAIN MEASURES Surveys collected hospital demographic factors along with 11 questions aimed at assessing the effectiveness of the hospital's COVID response. KEY RESULTS The response rate was 56% (71/127) from VA and 47% (415/881) from non-federal hospitals. Compared to VA hospitals, non-federal hospitals had a larger average number of acute care (214 vs. 103 beds, p<.001) and intensive care unit (24 vs. 16, p<.001) beds. VA hospitals were more likely to report no shortages of personal protective equipment or medical supplies during the pandemic (17% vs. 9%, p=.03) and more frequently opened new units to care specifically for COVID patients (71% vs. 49%, p<.001) compared with non-federal hospitals. Non-federal hospitals more frequently experienced increased loss of staff due to resignations (76% vs. 53%, p=.001) and financial hardships stemming from the pandemic (58% vs. 7%, p<0.001). CONCLUSIONS In our survey-based national study, lead infection preventionists noted several distinct advantages in VA versus non-federal hospitals in their ability to expand bed capacity, retain staff, mitigate supply shortages, and avoid financial hardship. While these benefits appear to be inherent to the VA's structure, non-federal hospitals can adapt their infrastructure to better weather future system shocks.
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Affiliation(s)
- Richard J Schildhouse
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Ashwin Gupta
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA
| | - M Todd Greene
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA
| | - Karen E Fowler
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA
| | - David Ratz
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA
| | - Mark S Hausman
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sanjay Saint
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,VA/UM Patient Safety Enhancement Program, Ann Arbor, MI, USA
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Crowley R, Atiq O, Hilden D, Cooney TG. Health Care for Our Nation's Veterans: A Policy Paper From the American College of Physicians. Ann Intern Med 2021; 174:1600-1602. [PMID: 34606323 DOI: 10.7326/m21-2392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Veterans Health Administration (VHA) is the United States' largest integrated health care delivery system, serving over 9 million enrollees at nearly 1300 health care facilities. In addition to providing health care to the nation's military veterans, the VHA has a research and development program, trains thousands of medical residents and other health care professionals, and conducts emergency preparedness and response activities. The VHA has been celebrated for delivering high-quality care to veterans, early adoption of electronic medical records, and high patient satisfaction. However, the system faces challenges, including implementation of an expanded community care program, modernization of its electronic medical records system, and providing care to a population with complex needs. The position paper offers policy recommendations on VHA funding, the community care program, medical and health care professions training, and research and development.
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Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C.)
| | - Omar Atiq
- University of Arkansas for Medical Sciences, Little Rock, Arkansas (O.A.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
| | - Thomas G Cooney
- Oregon Health & Science University, Portland, Oregon (T.G.C.)
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