Review of Community-Based Outpatient Clinics Closed Due to the COVID-19 Pandemic

The VA Office of Inspector General (OIG) reviewed community-based outpatient clinic (CBOC) closures that occurred due to the COVID-19 pandemic to evaluate the impact on patient care. The OIG virtually interviewed Veterans Health Administration (VHA) staff at 140 facilities that oversaw the 1,031 CBOCs that were operational prior to the World Health Organization’s pandemic declaration.Of these CBOCs, 173 were closed to face-to-face visits on or after February 1, 2020. Reasons for closure fell into four categories including (a) safety of patients and staff, (b) need for consolidation of resources, (c) lack of staff and personal protective equipment, and (d) small size of CBOC or proximity to other CBOCs or facilities.Clinicians of closed CBOCs triaged patients care needs and provided care options. The four most reported options used were telephone visit, VA Video Connect, rescheduled appointment for a later date, or an outpatient visit at the parent facility. Based on survey responses and interviews with facility leaders, the OIG concluded that, generally, patient care needs were not interrupted.Facility personnel frequently noted several impacts of the COVID-19 pandemic on CBOC operations:• Patient trust scores increased on the Veteran Signals survey.• Patients voiced appreciation of available care options.• Virtual care visits increased, which may positively affect patient access long-term.• Process changes such as drive-through testing and care services for pharmacy, laboratory, immunizations, prosthetics, and audiology were implemented.Other responses identified challenges encountered implementing virtual care and mitigating risk of patient and staff exposure to COVID-19, including problems with bandwidth and technical issues when using VA Video Connect at rural sites and limitations in housekeeping resources.Insights gained and shared related to CBOC closures can provide valuable information for VHA to incorporate into contingency planning for future emergencies and facilitate long term changes in care delivery.The OIG made no recommendations.