tetano
Editor, Senior Moderator
Med Care
. 2025 Nov 1;63(11):842-850.
doi: 10.1097/MLR.0000000000002194. Epub 2025 Oct 13. Reaching Consensus on Long COVID Symptoms and Patient-Reported Outcomes Across the Veterans Health Administration Using a Modified Hybrid Nominal Group-Delphi Approach
Amelia Schlak[SUP] 1 [/SUP], Ilana Seidel[SUP] 2 3 [/SUP], Omar Awan[SUP] 4 5 [/SUP], Jacqueline Neal[SUP] 6 7 [/SUP], Mayuree Rao[SUP] 8 9 [/SUP], Kristin Janssen[SUP] 10 [/SUP], Debra Warner[SUP] 10 [/SUP], Kelli Lee[SUP] 10 [/SUP], Angela Park[SUP] 10 [/SUP], Marian Adly[SUP] 11 [/SUP], Elizabeth Brill[SUP] 10 [/SUP], David Atkins[SUP] 4 4 [/SUP], Barbara E Jones[SUP] 12 13 [/SUP], Pandora L Wander[SUP] 8 9 [/SUP]
Affiliations
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.
Keywords: SARS-CoV-2 infection (PASC); long COVID; modified Delphi approach; patient reported outcomes; post-COVID-19 condition.
. 2025 Nov 1;63(11):842-850.
doi: 10.1097/MLR.0000000000002194. Epub 2025 Oct 13. Reaching Consensus on Long COVID Symptoms and Patient-Reported Outcomes Across the Veterans Health Administration Using a Modified Hybrid Nominal Group-Delphi Approach
Amelia Schlak[SUP] 1 [/SUP], Ilana Seidel[SUP] 2 3 [/SUP], Omar Awan[SUP] 4 5 [/SUP], Jacqueline Neal[SUP] 6 7 [/SUP], Mayuree Rao[SUP] 8 9 [/SUP], Kristin Janssen[SUP] 10 [/SUP], Debra Warner[SUP] 10 [/SUP], Kelli Lee[SUP] 10 [/SUP], Angela Park[SUP] 10 [/SUP], Marian Adly[SUP] 11 [/SUP], Elizabeth Brill[SUP] 10 [/SUP], David Atkins[SUP] 4 4 [/SUP], Barbara E Jones[SUP] 12 13 [/SUP], Pandora L Wander[SUP] 8 9 [/SUP]
Affiliations
- PMID: 41081723
- DOI: 10.1097/MLR.0000000000002194
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.
Keywords: SARS-CoV-2 infection (PASC); long COVID; modified Delphi approach; patient reported outcomes; post-COVID-19 condition.