Approaches to long covid care: The Veterans Health Administration experience in 2021

Abstract: Long COVID has challenged healthcare systems to organise care for a large group of complex patients at scale. Yet, despite these problems, the evidence base for long COVID care remains scant, with little criteria-standard, evidence-based practices to solve these problems. Therefore, we characterise how each facility within the large, multifacility Veterans Health Administration (VHA) healthcare system, one of the largest integrated healthcare systems in the USA serving over nine million veterans, approached the development, staffing and referral patterns of long COVID programmes. This project integrates two workstreams for information: (1) the Long COVID Environmental Scan and (2) the VHA Long COVID Learning Collaborative. The Long COVID Environmental Scan was developed from engagement with VHA subject matter experts and review of Centers for Disease Control and Prevention (CDC) documentation and additional authoritative guidance. Initiated through the Veterans Affairs (VA) Office of Innovation and Discovery, the 41-question survey focused on the use of clinical criteria, patient symptom screening, clinical screens used, and resources and staffing. Established in May 2021, the Long COVID Learning Collaborative was created through a grassroots effort of VHA facilities connecting with other facilities. The collaborative sought to articulate elements critical to long COVID care based on individuals’ and individual facility’s experience, while allowing flexibility in how they enact each element. Of 139 VHA facilities, 119 (86%) responded to the Long COVID Environmental Scan. Located in 10 VHA regions, 16 facilities reported established programmes. Of the 103 who did not currently have a long COVID-specific programme, 26 reported that they were considering a programme and 77 were not. Of the 77 not considering a programme, 67 reported plans to use existing primary care structures, including patient-aligned care teams. As of 18 December 2021, the VHA Long COVID Learning Collaborative has 125 members, representing 29 VA facilities engaged in its electronic platform. Early clinical topics focused on sharing approaches to issues such as fatigue, brain fog and olfactory dysfunction. Prominently featured were concerns about how to integrate with other, more established VA programmes, such as mental health, the VA’s Whole Health (including complementary medicine), diagnostic coding, vaccination programmes and qualifying for disability benefits. Given the magnitude of the pandemic, providing high-quality and effective long COVID care represents a significant and looming challenge for healthcare systems. These data suggest that even well-resourced healthcare systems such as the VHA are grappling with how to best address the next pandemic-related crisis: long COVID care. Emerging literature describes models of long COVID care across multiple healthcare systems, which is a valuable starting point for developing, standardising, implementing and evaluating long COVID care programmes. However, there is no real guidance on how to create a standardised or adaptive infrastructure for long COVID. This long COVID initiative has the potential to empower system-wide change that successfully engages and meets the changing needs of veterans, healthcare and communities over time.