QUERI – Quality Enhancement Research Initiative

QUERI E-news
May 2020

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QUERI Proposes Evaluation of VA Food and Lodging Policy for Direct Patient Care Providers

Led by Austin Frakt, PhD, PEPReC is one of QUERI’s designated resource centers. Its core mission includes refining VA measurements of access to care, productivity, demand, and capacity, as well as assessing relationships among these critical elements toward improving policy and planning. PEPReC also helps monitor and evaluate the impacts of major investments.

Takeaway: A proposal from QUERI investigators aims to evaluate whether a new VA policy to pay for food and lodging for direct patient care employees assisting with COVID-19 response at VAMCs will be effective in reducing staff shortages and mitigating imminent danger to human life. Results of this evaluation would inform VA’s rapid response efforts for future outbreaks of COVID-19 or other pandemics. This proposal demonstrates how QUERI can rapidly design evaluations that respond to urgent operational needs.

To help reduce the spread of COVID-19 and ensure there are enough employees to provide direct patient care during the COVID-19 outbreak, VA granted authority to Veterans Integrated Service Network (VISN) Directors to pay for food and lodging for vital employees assisting with COVID-19 response at VA Medical Centers (VAMCs). This is to encourage employees to continue working without worrying about placing members of their household at risk. This policy may have impacts on staff availability and well-being, as well as reducing community transmission rates of COVID-19. The goal of the proposed QUERI evaluation is to study the implementation of this policy and whether it reduces staff shortages and mitigates imminent danger to human life. These evaluation efforts will be coordinated and led by the Partnered Evidence-Based Policy Resource Center (PEPReC), with support from other QUERI centers.

Project goals

PEPReC will conduct analyses of existing VA and community data and coordinate evaluation efforts of clinical experts located at QUERI centers where the implementation and uptake of the lodging and meals policy differs. Contingent on VA leadership’s needs, evaluation modules may include the following goals:

  • Characterize roll-out of lodging and meals policy
    • Consult with VISN directors to identify which positions have been authorized to receive pay for lodging and meals at each VISN or VAMC
    • Identify time at which first provider in each VAMC requested pay for lodging and meals under this policy
  • Evaluate the policy’s impact on staff availability and retention
    • Estimate impact of presence and take-up of policy on staff availability and retention, controlling for potential variables (e.g., patient infection rates)
    • Assess extent to which variations on local resources affect the impact of lodging and meals policy on staff availability and retention
  • Evaluate the policy’s impact on staff burnout and fatigue
    • Survey providers post-pandemic
  • Identify extent to which the use of the policy varies with staff infection and mortality rates
  • Examine extent to which the use of the policy varies with community infection and mortality rates
    • Estimate associations among presence and take-up of policy and monthly community infection and mortality rates within counties with a high density of VA employees

Potential impact

Results of this proposed evaluation will be used to inform VA’s efforts to respond to future outbreaks of COVID-19 or other pandemics. It also serves as an example of QUERI’S rapid evaluation design capabilities.

For more information, please contact Melissa Garrido, PhD, Associate Director of PEPReC and Principal Investigator of the proposed study, at Melissa.Garrido@va.gov.

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