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Principal Investigator: Sara J Knight
Organization: VA SALT LAKE CITY HEALTHCARE SYSTEM
Fiscal Year: 2024
Funding agency: Veterans Affairs
Background: An estimated 10-50% of patients with a history of COVID-19 infection (C+) experience PASC.
PASC presents as a multisystem syndrome, with symptoms ranging in severity and regularity that can last
weeks to months after acute infection. These symptoms can lead to mild to severe functional limitations that
adversely impact quality of life. Emerging evidence suggests that inequities in PASC are experienced
especially by historically underserved populations (as with acute COVID-19). The lack of a standard case
definition risks burdening patients by delaying access to treatment and management. Yet currently there are no
evidence-based practices (EBP) for managing and treating PASC. Efforts to define PASC are urgently needed
to address knowledge gaps, advance discovery of EBPs, and improve care.
Significance: Our long-term goal is to ensure that every Veteran with PASC receives appropriate, timely, and
effective EBP to reduce PASC-related morbidity and maintain Veterans’ quality of life. Since the cumulative
cases of COVID-19 exceed 520,000 in VA, and 146 million in the US, and many are still at risk, our findings will
have broad public health impact within and beyond VA.
Innovation and Impact: VA has a unique opportunity to play a central role in defining PASC by leveraging its
multiple high-quality data sources, such as the COVID-19 Shared Data Resource. PASC definitions can be
derived from: 1) International Classification of Disease diagnosis codes, 2) electronic health record (EHR) chart
review, and 3) Veteran-reported symptom surveys. We propose to integrate these VA data sources and
mechanisms to identify a unified phenotypic description of PASC. Interviews with Veterans and other
stakeholders will further enrich our understanding of PASC. Collectively, these data will address research gaps
in understanding current PASC treatment models and assess variability and inequities in care.
Specific Aims: 1. Define and characterize PASC in the VA C+ population using EHR and survey data.
2. Characterize clinical management strategies and care delivery models for PASC, including pharmacological
and non-pharmacological treatments (e.g., Whole Health, Pain, Rehabilitation). 3. Assess health inequities in
PASC phenotypes, symptom trajectories, and management.
Methodology: In Aim 1 we will identify distinct symptom clusters among C+ Veterans in VA using
unsupervised clustering and examine the consequences of applying different criteria for PASC on estimation of
PASC incidence and on the relationship between PASC and symptom clusters. In Aim 2 we will characterize
clinical management leveraging EHR data and Veterans’ self-care via survey data. We will also conduct key
informant interviews in facilities with high and low C+ prevalence to determine how healthcare teams identify
PASC and select management and care delivery approaches. In Aim 3 we will examine relationships between
Aims 1-2 metrics and social determinants of health. We will also evaluate Veterans’ health and care
experiences with PASC using video interview methodologies of the Health Experiences Research Network.
Next Steps/Implementation: By completing these aims, we will provide a comprehensive, actionable
definition of PASC. Using our definition, we will address gaps in understanding the epidemiology, health
services utilized, and inequities related to PASC. This knowledge will advance efforts in developing EBPs for
PASC.
Terms: <Access to Care><Address><COVID-19><COVID-19 infection><COVID-19 positive><COVID-19 positivity><COVID-19 virus infection><COVID19 infection><CV-19><Caring><Chronic><Clinical><Clinical Management><Code><Coding System><Consensus><Coronavirus Infectious Disease 2019><Data><Data Sources><Diagnosis><Electronic Health Record><Epidemiology><Evaluation><Evidence based practice><Face><Goals><Health><Health Care Team><Health Inequity><Health Services Accessibility><Health Surveys><Healthcare Team><Incidence><Inequalities in Health><Inequities in Health><Inequity><International Classification of Diseases><International Statistical Classification of Diseases and Related Health Problems><Interview><Knowledge><Long COVID><Long COVID-19><Long coronavirus disease><Long coronavirus disease 2019><Medical Care Team><Medical Rehabilitation><Methodology><Methods><Mission><Modeling><Morbidity><Morbidity - disease rate><Non-pharmacologic Therapy><Nonpharmacologic Intervention><Nonpharmacologic Therapy><Nonpharmacologic approach><Nonpharmacologic treatment><Outcome><PASC><Pain><Painful><Patients><Pattern><Pharmacological Treatment><Phenotype><Play><Population><Post Acute Sequelae of COVID19><Post Acute Sequelae of SARS-CoV-2><Post Acute Sequelae of SARS-CoV2><Post Acute Sequelae of severe acute respiratory syndrome coronavirus 2><Post-Acute Sequelae of SARS-CoV-2 Infection><Practice Management><Prevalence><Provider><Public Health><QOL><Quality of life><Rehabilitation><Rehabilitation therapy><Reporting><Research><Risk><Role><SARS-CoV-2 infection><SARS-CoV-2 infection history><SARS-CoV-2 positive><SARS-CoV-2 positivity><SARS-CoV2 infection><Self Care><Service delivery model><Service model><Severe acute respiratory syndrome coronavirus 2 infection><Severe acute respiratory syndrome coronavirus 2 positive><Severe acute respiratory syndrome coronavirus 2 positivity><Severities><Standardization><Survey Instrument><Surveys><Symptoms><Syndrome><System><Testing><Underserved Population><Veterans><Veterans Health Administration><Veterans Health Affairs><access to health services><access to services><access to treatment><accessibility to health services><acute COVID-19><acute SARS-CoV-2 infection><acute infection><acute phase of COVID-19><acute phase of SARS-CoV-2 infection><adverse consequence><adverse outcome><adverse sequelae of COVID><adverse sequelae of COVID-19><adverse sequelae of coronavirus disease><adverse sequelae of coronavirus disease 2019><availability of services><biological systems><care access><care delivery><care delivery model><chronic COVID><chronic COVID-19><chronic COVID-19 sequelae><chronic novel coronavirus disease 2019><clinical phenotype><coronavirus disease 2019><coronavirus disease 2019 infection><coronavirus disease 2019 positive><coronavirus disease 2019 positivity><coronavirus disease-19><coronavirus infectious disease-19><crosslink><data sharing networks><data sharing resource><design><designing><disease diagnosis><effective therapy><effective treatment><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><epidemiologic><epidemiological><experience><faces><facial><health assessment><health care delivery model><health inequalities><health service access><health service use><health service utilization><health services availability><healthcare delivery model><high risk><history of COVID infection><history of COVID-19 infection><improved><infected with COVID-19><infected with COVID19><infected with SARS-CoV-2><infected with SARS-CoV2><infected with coronavirus disease 2019><infected with severe acute respiratory syndrome coronavirus 2><informant><innovate><innovation><innovative><long haul COVID><long haul COVID-19><long haul coronavirus disease><long haul coronavirus disease 2019><long haul sequelae of COVID-19><long haul sequelae of coronavirus disease 2019><long-hauler COVID><long-hauler COVID-19><long-hauler coronavirus disease 2019><long-hauler syndrome><long-term COVID><long-term COVID-19><long-term coronavirus disease><long-term coronavirus disease 2019><long-term sequelae of COVID-19><long-term sequelae of SARS-CoV-2><long-term sequelae of coronavirus disease 2019><long-term sequelae of severe acute respiratory syndrome coronavirus 2><longterm COVID><longterm COVID-19><longterm coronavirus disease><longterm coronavirus disease 2019><military veteran><non-drug therapy><non-drug treatment><nondrug therapy><nondrug treatment><novel><persistent COVID-19><personal care><post COVID syndrome><post COVID-19 sequelae><post COVID-19 syndrome><post acute COVID syndrome><post acute COVID-19><post acute COVID-19 syndrome><post acute SARS-CoV-2><post acute coronavirus disease 2019><post acute coronavirus disease 2019 syndrome><post acute coronavirus disease syndrome><post acute sequelae following COVID-19><post acute severe acute respiratory syndrome coronavirus 2><post coronavirus disease 2019 syndrome><post coronavirus disease syndrome><post-COVID><post-COVID-19><post-acute phases of COVID-19><post-acute sequelae following SARS-CoV-2 infection><post-acute sequelae of COVID-19><post-acute sequelae of acute COVID infection><post-acute sequelae of coronavirus disease 2019><post-coronavirus disease 2019><prolonged COVID-19 symptoms><rehab therapy><rehabilitative><rehabilitative therapy><service availability><social health determinants><social role><symptom cluster><symptomatology><treatment access><under served group><under served individual><under served people><under served population><underserved group><underserved individual><underserved people><unsupervised clustering><veteran population><whole health><whole person health>