# Maintaining Preventive Care during Public Health Emergencies through Effective Coordination

> **NIH VA I01** · MICHAEL E DEBAKEY VA MEDICAL CENTER · 2024 · —

## Abstract

BACKGROUND. Screening lies at the heart of preventive care. However, COVID-19 has dramatically disrupted
routine screening efforts, resulting in excess veteran mortality not directly attributable to COVID-19. Screening
rates at VA during COVID have varied markedly by facility and clinical condition. This is illustrated in cancer
and mental health screening; cross-facility variability exists for each, suggesting susceptibilities in the capacity
and workflow of the screening and referral process. To better understand these susceptibilities and identify
new practices to mitigate interrupted care, we propose a qualitative study comparing facilities that exhibited
high, low, and highly variable performance (respectively) in screening rates before and during the pandemic.
SIGNIFICANCE. Disruptions to preventive screening lead to excess veteran mortality. Therefore, caring for
veterans’ regular primary care (PC) needs while fulfilling our Fourth Mission (emergency preparedness)
requires top-notch coordination and nimble teamwork from all clinical personnel. Our study will identify the
systematic strategies and coordination patterns between primary and specialty care that differentiate
successful facilities from struggling ones. Our findings will help design new or adapt existing workflows and
interventions for coordination, shaping how screening and preventive care is delivered during and beyond
COVID-19. Our study directly addresses: a) this solicitation’s goals; b) HSR&D’s clinical priorities; c) VA’s
strategic plan goals for highly reliable care; and d) ORD real-world research impact priorities.
SPECIFIC AIMS. Using cancer and mental health screening rates as exemplars, we propose to (1) Compare
how PACTs from VHA facilities of varying screening performance patterns (high, low, improving, plummeting,
variable) during the COVID-19 pandemic coordinated (a) as a team to conduct screening services, and (b) with
specialty care teams at their facility to conduct screening services; and (2) Compare team, facility, and system-
based barriers, facilitators, and strategies for continuing screening services during the COVID-19 pandemic
amongst PACTs from VHA facilities of varying screening performance patterns during that period.
METHOD. Design and Participants. This multi-method study consists of qualitative analysis of interviews and
focus groups with primary care personnel, leadership, and patients at 10 VA Medical Centers (VAMCs).
Site Selection. We will select study sites using a purposive stratified approach based on site rurality, COVID-19
caseload at the beginning of the pandemic, and performance on five outpatient clinical performance indicators
of cancer and mental health screening. Sites will be categorized into one of five screening performance
groups: high performers, low performers, improvers, plummeters, and highly variable.
Procedure. Using data from prior research by the PI, we will create process maps for each performance
measure to create a b...

## Key facts

- **NIH application ID:** 10752629
- **Project number:** 5I01HX003571-02
- **Recipient organization:** MICHAEL E DEBAKEY VA MEDICAL CENTER
- **Principal Investigator:** SYLVIA J. HYSONG
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-10-01 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10752629

## Citation

> US National Institutes of Health, RePORTER application 10752629, Maintaining Preventive Care during Public Health Emergencies through Effective Coordination (5I01HX003571-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10752629. Licensed CC0.

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