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Quality Enhancement Research Initiative

QUERI E-news
September 2021

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Rapid Response Team Examines Vaccine Rollout: Informing VHA innovation

On August 23, 2021, the FDA formally approved the Pfizer vaccine, which should help allay concerns about the vaccine.

Several QUERI groups are conducting evaluations related to the COVID-19 pandemic, particularly in regard to the vaccine rollout. Led by Drs. A. Rani Elwy, D. Keith McInnes, Amanda Midboe, and David Smelson, the Bridging the Care Continuum for Vulnerable Veterans across VA and Community Care (Bridge QUERI) and its Rapid Response Team (RRT) examined Veterans’ and VA employees’ views on COVID-19 vaccines, as well as their perceptions of VA initiatives to vaccinate Veterans and employees. Working with the Survey of Healthcare Experience of Patients (SHEP) Veteran Insight Panel, the RRT surveyed 1,178 Veterans between March 12 and 28, 2021 about their attitudes and intentions regarding COVID-19 vaccination. Fears about side effects and worry about the newness of vaccines were the primary reasons for not getting vaccinated, reflecting vaccine skepticism and deliberation. Those in worse health were more unsure about vaccination. Benefits to one’s own health and impact on family and society were the top reasons reported for getting vaccinated. VA and VA healthcare providers were reported to be among Veterans’ top trusted sources of information.

VA and VA healthcare providers were reported to be among Veterans’ top trusted sources of information.

It was a delight to see how fast this collaboration between QUERI, the National Center for Health Promotion and Disease Prevention (NCP), and the SHEP program came together, and the speed with which it produced meaningful input for policymakers and senior VA leaders. Joe Francis, MD, Executive Director, VA Office of Analytics and Performance Integration

The RRT also conducted semi-structured interviews involving employees (n=31) and Veterans (n=27) – and 5 Veterans from a national stakeholder organization participated in a focus group – as part of a quality improvement (QI) project between January and June 2021 at three VA medical centers.  A subset of Veterans (n=14) and employees (n=8) identified as vaccine hesitant. Vaccine hesitancy was related to perceptions of politics and policies, historical influences, knowledge or awareness of vaccines, perceived susceptibility to COVID-19, the vaccine development process, and military experiences. Facilitators for vaccination involved talking with trusted others, ease of vaccine access, and perceptions of family and societal benefits of vaccines.

The VA All Employee Survey is a “living document” originally developed in 2001 to help VA assess workforce satisfaction and organizational climate. The instrument has been refined several times since then in response to operational inquiries by VA leadership on organizational health relationships and VA culture.

The infographics created by the Bridge QUERI RRT are a great way for busy clinicians and staff to quickly learn about the high points and use them in practice. The RRT results are especially timely given that we, as a system, are working hard to promote vaccine acceptance during the current surge of the Delta variant. Jane Kim, MD, MPH, Chief Consultant for Preventive Medicine, NCP

Working with the National Center for Health Promotion and Disease Prevention (NCP), and building on these QI findings, the RRT created a “3-Step Plan for Reaching Vaccine Acceptance” which was selected as a VHA Innovation Ecosystem Vaccine Acceptance Promising Practice – and has been disseminated across the VA healthcare system. This plan involves patient-centered communication strategies delivered by trusted healthcare providers and focuses on addressing expected benefits for family, friends, and society. In addition to this work, the NCP asked Bridge QUERI RRT to develop four COVID-19 vaccine questions for the 2021 All Employee Survey (AES). The RRT recently analyzed AES responses to these four questions and shared the data with NCP leadership and Dr. Steven Lieberman, to assist VA in planning for its vaccine mandate among employees, and booster doses among Veterans and employees.

Bridge QUERI RRT has been instrumental in building awareness of the complexities of vaccine confidence and hesitance.Michael Goldstein, MD, Associate Chief Consultant for Preventive Medicine, NCP

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