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BACKGROUND: There are knowledge gaps about factors associated with acute kidney injury (AKI) among COVID-19 patients. To examine AKI predictors among COVID-19 patients, a retrospective longitudinal cohort study was conducted between January 2020 and December 2022. Logistic regression models were used to examine predictors of AKI, and survival analysis was performed to examine mortality in COVID-19 patients. RESULTS: A total of 742,799 veterans diagnosed with COVID-19 were included and 95,573 were hospitalized within 60 days following COVID-19 diagnosis. A total of 45,754 developed AKI and 28,573 AKI patients were hospitalized. Use of vasopressors (OR = 14.73; 95% CL 13.96-15.53), history of AKI (OR = 2.22; CL 2.15-2.29), male gender (OR = 1.90; CL 1.75-2.05), Black race (OR = 1.62; CL 1.57-1.65), and age 65+ (OR = 1.57; CL 1.50-1.63) were associated with AKI. Patients who were vaccinated twice and boosted were least likely to develop AKI (OR = 0.51; CL 0.49-0.53) compared to unvaccinated COVID-19 patients. Patients receiving two doses (OR = 0.77; CL = 0.72-0.81), or a single dose (OR = 0.88; CL = 0.81-0.95) were also less likely to develop AKI compared to the unvaccinated. AKI patients exhibited four times higher mortality compared to those without AKI (HR = 4.35; CL 4.23-4.50). Vaccinated and boosted patients had the lowest mortality risk compared to the unvaccinated (HR = 0.30; CL 0.28-0.31). CONCLUSION: Use of vasopressors, being unvaccinated, older age, male gender, and Black race were associated with post COVID-19 AKI. Whether COVID-19 vaccination, including boosters, decreases the risk of developing AKI warrants additional studies.

Abstract Background The COVID-19 pandemic rapidly altered dental practice, training, and education. This study investigates the pandemic’s impacts on the clinical training experiences of dental and dental hygienist trainees at the US Department of Veterans Affairs (VA). Methods Using data from post-doctoral general practice dentists, dental specialists, and dental hygienist trainees who completed the VA Trainee Satisfaction Survey before and during COVID-19, we performed logistic regression and thematic content analyses to determine whether COVID-19 was associated with training satisfaction and likelihood of considering future VA employment. Results While post-doctoral dentist and dental specialty trainees did not report significant differences, dental hygienist trainees reported increased overall satisfaction and an increased likelihood to consider future VA employment during the pandemic compared to before the pandemic. Similar reasons for dissatisfaction were identified for both the pre-pandemic and pandemic groups. Conclusions Research outside VA indicates the pandemic’s association with trainees’ intentions to leave health profession education programs. Our results suggest the likely existence of factors that could lead to positive changes for at least some portion of the dental workforce. Future studies should explore those potential factors as some may be replicable in other settings or may apply to other health professions.

Objectives: While extensive research has focused on patient outcomes in skilled nursing facilities, a critical gap remains in understanding factors influencing their managerial performance, particularly occupancy rates. This study examines the occupancy rates of skilled nursing facilities and assesses the significance of two important drivers of managerial performance that have not received sufficient attention—the influence of payer mix and total profit margin. Specifically, we focused on the role played by a nursing home’s financial performance (as assessed by profit margin) in influencing the relationship between payer mix and occupancy rate among skilled nursing facilities. Methods: Data were extracted from the 2019 to 2020 Joint Annual Report of Nursing Homes for a sample of 612 skilled nursing facilities in Tennessee, USA. Regression analysis was performed by fitting a generalized estimating equation of occupancy rate. Results: Compared to skilled nursing facilities in the lowest quartile of profit margin, for example, those in the highest quartile had approximately 18 percentage points higher occupancy rates per unit increase in resident days of care covered by traditional Medicare (β = 0.18, p = 0.0028). Similarly, skilled nursing facilities in the second highest quartile of profit margin had a higher occupancy rate by approximately 23 percentage points per unit increase in Medicare Advantage (β = 0.23, p = 0.0375) when compared to those in the lowest quartile of profit margin. Conclusions: Skilled nursing facilities with stronger financial performance generally have higher occupancy rates, particularly notable in relation to an upswing in payer sources such as traditional Medicare and Medicare Advantage, when compared to skilled nursing facilities with weaker profitability. Given the increasingly larger role of Medicare in long-term care funding, policymakers and nursing home managers may find it useful to consider our findings when evaluating opportunities to enhance managerial performance of skilled nursing facilities.

Introduction The emergence of COVID-19 caused a sudden, unexpected disruption in the clinical training experiences of nurse trainees at the US Department of Veterans Affairs (VA), the largest clinical training setting in the US for nurses. Purpose To understand associations between COVID-19 and nurse trainees’ satisfaction with their training experiences and the likelihood that they would consider future VA employment. Methods A cross-sectional design was used to assess 7,890 nurse responses from the VA's Trainee Satisfaction Survey for academic years 2018–2021. Results After the pandemic, trainees reported decreased training satisfaction (95.06% vs. 93.46%; P = .0028). Willingness to consider future VA employment was unchanged. Patient case mix, the onboarding process, and challenges with other staff were the most common reasons for dissatisfaction. Conclusion Nurse trainees expressed a small but statistically significant degree of dissatisfaction with their clinical learning environment during this study period but their willingness to seek employment with the VA remained high.

Abstract Background Compared to the general population, individuals experiencing homelessness are at greater risk of excess morbidity and mortality from COVID-19 but have been vaccinated at lower rates. The U.S. Department of Veterans Affairs (VA)’s Homeless Patient Aligned Care Team (HPACT) program integrates health care and social services for Veterans experiencing homelessness to improve access to and utilization of care. Methods This study explores the vaccination uptake behavior and attitudes through a qualitative comparative case study of two HPACT clinics, one in California (CA) and one in North Dakota (ND). Semi-structured telephone interviews were conducted with Veterans enrolled in the two VA HPACT clinics from August to December 2021 with 20 Veterans (10 at each clinic). Results Four themes emerged from the interviews: (1) Vaccination uptake and timing— While half of the Veterans interviewed were vaccinated, ND Veterans were more likely to be vaccinated and got vaccinated earlier than CA Veterans; (2) Housing— Unsheltered or precariously housed Veterans were less likely to be vaccinated; (3) Health Care— Veterans reporting positive experiences with VA health care and those who trusted health providers were more likely to vaccinate than those with negative or nuanced satisfaction with health care; (4) Refusers’ Conspiracy Theories and Objectivity Claims— Veterans refusing the vaccine frequently mentioned belief in conspiracy theories while simultaneously asserting their search for objective information from unbiased sources. Conclusions These findings amplify the importance of improving access to population-tailored care for individuals experiencing homelessness by reducing patient loads, expanding housing program enrollment, and increasing the provider workforce to ensure personalized care. Health care providers, and housing providers, social workers, and peers, who offer information without discrediting or criticizing Veterans’ beliefs, are also key to effectively delivering vaccine messaging to this population.

BackgroundWith the rapid shift to telehealth, there remains a knowledge gap in how video-based care is implemented in interdisciplinary primary care (PC) settings. ObjectiveThe objective of this study was to gain an in-depth understanding of how video telehealth services were implemented in PC from the perspectives of patients and interdisciplinary PC team members at the Veterans Health Administration (VHA) 2 years after the onset of the COVID-19 pandemic. MethodsWe applied a positive and negative deviance approach and selected the 6% highest (n=8) and the 6% lowest (n=8) video-using PC sites in 2022 from a total of 130 VHA medical centers nationally. A total of 12 VHA sites were included in the study, where 43 PC interdisciplinary team members (August-October 2022) and 25 patients (February-May 2023) were interviewed. The 5 domains from the diffusion of innovation theory and the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework guided the development of the 2 study interview guides (provider and patient). We identified themes that emerged across all interviews that were associated with the implementation of video-based care in interdisciplinary PC settings, using directed-content rapid analysis of the interview transcripts. The analysis was guided by 5 a priori NASSS domains: (1) patient condition or characteristic, (2) technology, (3) adopter system, (4) health care organization, and (5) adaptation over time. ResultsThe study findings include the following common themes and factors, organized by the 5 NASSS domains: (1) patient condition or characteristic—visit type or purpose (eg, follow-up visits that do not require physical examination), health condition (eg, homebound or semihomebound patients), and sociodemographic characteristic (eg, patients who have a long commute time); (2) technology—key features (eg, access to video-enabled devices), knowledge (eg, how to use videoconferencing software), and technical support for patients and providers; (3) adopter system—changes in staff roles and clinical practice (eg, coordination of video-based care), provider and patient preference or comfort to use video-based care, and caregiver’s role (eg, participation of caregivers during video visits); (4) health care organization—leadership support and access to resources, scheduling for video visits (eg, schedule or block off digital half or full days), and training and telehealth champions (eg, hands-on or on-site training for staff, patients, or caregivers); (5) adaptation over time—capacity to improve all aspects of video-based care and provide continued access to resources (eg, effective communication about updates). ConclusionsThis study identified key factors associated with the implementation of video-based services in interdisciplinary PC settings at the VHA from the perspectives of PC team members and patients. The identified multifaceted factors may inform recommendations on how to sustain and improve the provision of video-based care in VHA PC settings as well as non-VHA patient-centered medical homes.

Background: There are knowledge gaps about factors associated with acute kidney injury (AKI) among COVID-19 patients. To examine AKI predictors among COVID-19 patients, a retrospective longitudinal cohort study was conducted between January 2020 and December 2022. Logistic regression models were used to examine predictors of AKI, and survival analysis was performed to examine mortality in COVID-19 patients. Results: A total of 742,799 veterans diagnosed with COVID-19 were included and 95,573 were hospitalized within 60 days following COVID-19 diagnosis. A total of 45,754 developed AKI and 28,573 AKI patients were hospitalized. Use of vasopressors (OR = 14.73; 95% CL 13.96–15.53), history of AKI (OR = 2.22; CL 2.15–2.29), male gender (OR = 1.90; CL 1.75–2.05), Black race (OR = 1.62; CL 1.57–1.65), and age 65+ (OR = 1.57; CL 1.50–1.63) were associated with AKI. Patients who were vaccinated twice and boosted were least likely to develop AKI (OR = 0.51; CL 0.49–0.53) compared to unvaccinated COVID-19 patients. Patients receiving two doses (OR = 0.77; CL = 0.72–0.81), or a single dose (OR = 0.88; CL = 0.81–0.95) were also less likely to develop AKI compared to the unvaccinated. AKI patients exhibited four times higher mortality compared to those without AKI (HR = 4.35; CL 4.23–4.50). Vaccinated and boosted patients had the lowest mortality risk compared to the unvaccinated (HR = 0.30; CL 0.28–0.31). Conclusion: Use of vasopressors, being unvaccinated, older age, male gender, and Black race were associated with post COVID-19 AKI. Whether COVID-19 vaccination, including boosters, decreases the risk of developing AKI warrants additional studies.

Introduction: The emergence of COVID-19 caused a sudden, unexpected disruption in the clinical training experiences of nurse trainees at the US Department of Veterans Affairs (VA), the largest clinical training setting in the US for nurses. Purpose: To understand associations between COVID-19 and nurse trainees' satisfaction with their training experiences and the likelihood that they would consider future VA employment. Methods: A cross-sectional design was used to assess 7,890 nurse responses from the VA's Trainee Satisfaction Survey for academic years 2018–2021. Results: After the pandemic, trainees reported decreased training satisfaction (95.06% vs. 93.46%; P =.0028). Willingness to consider future VA employment was unchanged. Patient case mix, the onboarding process, and challenges with other staff were the most common reasons for dissatisfaction. Conclusion: Nurse trainees expressed a small but statistically significant degree of dissatisfaction with their clinical learning environment during this study period but their willingness to seek employment with the VA remained high. [ABSTRACT FROM AUTHOR]

The authors address the specific relationship of social work burnout to social workers' prior traumas. Cited are the trauma trigger fatigue experienced by social workers during the COVID-19 pandemic, the exacerbation of social work burnout during the pandemic, and the need to utilize a systematic approach to burnout that targets the culture of healthcare and the environment in which providers operate to better meet the needs of the workforce.

The job demands–resources (JD-R) theory explicates factors that facilitated social worker burnout prepandemic. Authors believe the JD-R theory can illustrate how certain factors facilitated social worker job retention in the novel context of the pandemic because a sizable group of social workers resisted burnout-related turnover. Disseminating these factors can benefit the profession. Qualitative cross-sectional data were elicited from a semistructured interview about experiences of U.S. Department of Veterans Affairs (VA) outpatient social workers (N = 13) who provided care during the pandemic. Authors conducted content analysis and coded the text into six themes of factors that facilitated retention: (1) commitment to serving veteran population, (2) job flexibility, (3) supportive colleagues, (4) leadership support, (5) maintaining normal routines, and (6) trusting in scientific/evidence-based practices. Application of the JD-R theory illustrated how social workers utilized specific resources that balanced job demands during the pandemic and facilitated job retention. Future work should apply the JD-R theory among larger samples of VA social workers, as well as non-VA social workers, in the context of the pandemic, for comparative purposes. Authors conclude with policy implications related to the impact of permanently allowing telework options and job flexibility options among social workers. [ABSTRACT FROM AUTHOR]

Purpose: The coronavirus disease 2019 (COVID-19) pandemic limited healthcare professional education and training opportunities in rural communities. Because the US Department of Veterans Affairs (VA) has robust programs to train clinicians in the United States, this study examined VA trainee perspectives regarding pandemic-related training in rural and urban areas and interest in future employment with the VA., Methods: Survey responses were collected nationally from VA physicians and nursing trainees before and after COVID-19 (2018 to 2021). Logistic regression models were used to test the association between pandemic timing (pre-pandemic or pandemic), trainee program (physician or nurse), and the interaction of trainee pandemic timing and program on VA trainee satisfaction and trainee likelihood to consider future VA employment in rural and urban areas., Results: While physician trainees at urban facilities reported decreases in overall training satisfaction and corresponding decreases in the likelihood of considering future VA employment from pre-pandemic to pandemic, rural physician trainees showed no changes in either outcome. In contrast, while nursing trainees at both urban and rural sites had decreases in training satisfaction associated with the pandemic, there was no corresponding effect on the likelihood of future employment by nurses at either urban or rural VA sites., Conclusion: The study’s findings suggest differences in the training experiences of physicians and nurses at rural sites, as well as between physician trainees at urban and rural sites. Understanding these nuances can inform the development of targeted approaches to address the ongoing provider shortages that rural communities in the United States are facing.