Reaching Consensus on Long COVID Symptoms and Patient-Reported Outcomes Across the Veterans Health Administration Using a Modified Hybrid Nominal Group-Delphi Approach

Authors

Amelia Schlak, Department of Veterans Affairs, Health System Research Portfolio, Office of Research and Development, Washington, DC.
Ilana Seidel, San Francisco VA Health Care System, San Francisco, CA.
Omar Awan, Washington DC VA Medical Center, Washington, DC.
Jacqueline Neal, Jesse Brown VA Medical Center, Chicago, IL.
Mayuree Rao, VA Puget Sound Health Care System, Seattle, WA.
Kristin Janssen, Department of Veteran Affairs, Clinical Services, Washington, DC.
Debra Warner, Department of Veteran Affairs, Clinical Services, Washington, DC.
Kelli Lee, Department of Veteran Affairs, Clinical Services, Washington, DC.
Angela Park, Department of Veteran Affairs, Clinical Services, Washington, DC.
Marian Adly, Department of Veterans Affairs, National Artificial Intelligence Institute, Office of Research and Development, Washington, DC.
Elizabeth Brill, Department of Veteran Affairs, Clinical Services, Washington, DC.
David Atkins, Washington DC VA Medical Center, Washington, DC.
Barbara E. Jones, Department of Veterans Affairs, Informatics Decision Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT.
Pandora L. Wander, VA Puget Sound Health Care System, Seattle, WA.

Document Type

Journal Article

Publication Date

11-1-2025

Journal

Medical care

Volume

63

Issue

11

DOI

10.1097/MLR.0000000000002194

Keywords

SARS-CoV-2 infection (PASC); long COVID; modified Delphi approach; patient reported outcomes; post-COVID-19 condition

Abstract

BACKGROUND: A consistent approach to track Long COVID symptoms at the Veterans Health Administration (VHA) was lacking. OBJECTIVES: To reach consensus among clinical stakeholders on how long COVID symptoms should be assessed at VHA outpatient visits and recommend an assessment battery. RESEARCH DESIGN: Hybrid Delphi-Nominal Group approach. SUBJECTS: Members of the VHA Long COVID Field Advisory Board (FAB) and the VHA Long COVID Community of Practice (CoP) participated. Veteran stakeholders provided input. MEASURES: A literature review and clinician questionnaires identified 68 instruments across 14 symptom domains. In the first consensus round, FAB members excluded instruments with limited clinical usability. The remaining 25 instruments were ranked by CoP members. Multiple rounds of asynchronous voting were conducted until one instrument remained per domain. The top instruments were grouped into 3 batteries. Final consensus on a preferred battery was reached through additional voting. Veterans from the Los Angeles Veteran Engagement Panel assessed clarity, burden, and feasibility. RESULTS: The final battery included the Modified Yorkshire COVID-19 Rehabilitation Survey, VHA Whole Health Well-Being Signs, the Exercise Vital Signs Questionnaire, and the 2-Minute Step Test. Whole Health questions were also included to support the VHA's Whole Health System mission. Symptom-specific instruments already used in VHA routine care were not included in the final battery, as clinics already had access to them. CONCLUSIONS: A structured, rapid consensus process was used to identify a battery of symptom instruments to standardize Long COVID symptom assessment across VHA clinics.

APA Citation

Schlak, Amelia; Seidel, Ilana; Awan, Omar; Neal, Jacqueline; Rao, Mayuree; Janssen, Kristin; Warner, Debra; Lee, Kelli; Park, Angela; Adly, Marian; Brill, Elizabeth; Atkins, David; Jones, Barbara E.; and Wander, Pandora L., "Reaching Consensus on Long COVID Symptoms and Patient-Reported Outcomes Across the Veterans Health Administration Using a Modified Hybrid Nominal Group-Delphi Approach" (2025). GW Authored Works. Paper 8188.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8188

Department

Medicine