Lessons Learned From a Nationwide Implementation of Airborne Hazards and Open Burn Pits Registry Clinical Examinations: A Qualitative Assessment

INTRODUCTION: The Airborne Hazards and Open Burn Pits Registry (AHOBPR) examination was a service for Veterans with concerns about environmental exposures during military deployments. Interested Veterans enrolled in the AHOBPR online, completed a questionnaire, and indicated interest in a clinical examination by a Veterans Health Administration clinician. Several factors (e.g., COVID, unanticipated demand, and personnel turnover) resulted in a large number of pending examinations nationwide by 2022, prompting an evaluation and implementation effort to accelerate completion of high-quality examinations.Our objective was to assess Veterans' and clinical team members' perspectives of AHOBPR examinations to improve their delivery. METERIALS AND METHODS: Qualitative interviews with Veterans who had completed an AHOBPR examination and clinical team members (CTMs) at 2 Veterans Affairs (VA) sites participating in our implementation. We recruited Veterans within 6 months of completing their examination and home facility complexity and performance metrics. We recruited CTMs for interviews from 2 purposefully selected VA facilities that completed all assessments conducted by our implementation team. Interviews were conducted between September 2022 and January 2023. We analyzed transcripts using rapid analysis. We apply the Promoting Action on Research Implementation in Health Service (PARiHS) framework to inform our interpretation of findings. RESULTS: Twenty-one Veterans and 9 CTMs from 2 sites completed interviews. Themes identified in the interviews were consistent with the PARiHS elements of evidence, context, and facilitation. Both Veterans and CTMs wanted evidence of appropriate knowledge about the AHOBPR and deployment and understanding AHOBPR structures and facility processes, including appropriate documentation of Veteran concerns. Contextually, Veterans and CTMs shared their strategies or experiences in clinical interactions especially the focus on developing patient-provider rapport and being prepared for examinations. Examples of facilitation included both groups' personal and professional motivations for conducting or pursuing examinations. Facilitation also involved local administrators and leaders providing the necessary staff, support, and resources. CONCLUSIONS: Assessing Veteran and clinical team member (CTM) perceptions of AHOBPR examinations revealed clinically relevant opportunities important to addressing military and environmental exposure concerns of veterans (i.e., "exposure-informed care"). Clinical leaders can use the PARiHS framework and lessons learned from the AHOBPR experience to assess implementation and improve delivery of other novel services.