Southeast Michigan was hit particularly hard by the first wave of the COVID-19 outbreak in March and April of 2020. Private healthcare systems around the area quickly began to fill to capacity as the coronavirus spread.

The VA Ann Arbor Medical Center and the VA Detroit Medical Center – hospitals typically reserved for our nation's Veterans – were called on during the centennial pandemic to enact it's little known, but critically important Fourth Mission.

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"The COVID pandemic was in its early days, but we noticed that the southeast Michigan/Detroit area, in particular, was really becoming one of the national epicenters," says Ashwin Gupta, M.D., a hospitalist at the University of Michigan and Ann Arbor Veteran's Administration Medical Center. "As part of the VA, there is something called the Fourth Mission. The Fourth Mission provides a number of different support services from the Veterans Affairs Administration to the community, among which is the possibility for non-Veterans patients to be hospitalized in VA Medical Centers. "

Starting in April, as other hospitals were running out of beds, the two southeast Michigan VA medical centers began to take on non-Veteran patients for the first time in their history. A total of 55 non-Veteran patients were transferred to the VA facilities in Detroit and Ann Arbor.

A recently published study, titled The Non-Veteran Experience at Veterans Affairs Medical Centers During the COVID-19 Pandemic: A Survey-Based Study, led by Gupta, captured that experience of non-Veteran patients who were admitted to the VA hospitals. The results of the study, published in the Journal of General Internal Medicine, were overwhelmingly positive for both hospitals.

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Few studies have compared VA healthcare to private healthcare before, and those studies primarily focused on meeting specific goals or targets. Gupta's study was the first to survey non-Veteran patients based on their actual experience with the VA.

"This is unique in that it offers the non-Veteran experience and that's not an experience that's been captured in the literature previously," Gupta says.

Twenty-three non-Veteran patients elected to take part in the survey after their discharge, with 18 of them being COVID-19 positive upon admission. The two hospitals admitted any patients that were sent their way, regardless of COVID-19 diagnosis prior to admission.

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The results show that 20 of the 23 patients were satisfied with the overall care they received at VA. Eleven indicated that they received better overall care at VA compared to the facility that they came from, while another 10 said the care was about the same. Nearly 80% of those surveyed said they were very or somewhat likely to recommend VA care others. Perhaps most importantly, 22 of the 23 surveyed said the doctors were better or about the same at the VA compared to the hospital that they came from, and 21 of the 23 communicated the same information about VA's nursing staff.

Gupta credits the mission-focused mindset of the clinicians at Detroit and Ann Arbor VA for seamlessly adjusting to the sudden transition the COVID-19 pandemic brought on. 

"The sense of mission, the sense of purpose. I know that everyone comes into work wanting to take the absolute best care of Veterans and to take care of these who served us. It's just really wonderful when folks outside the VA can experience just a bit of the things that we try to do for our Veterans on a daily basis," Dr. Gupta says.

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Paper cited: "The Non-Veteran Experience at Veterans Affairs Medical Centers During the COVID-19 Pandemic: a Survey-Based Study," J Gen Intern Medicine. DOI: 10.1007/s11606-021-06643-6

This story originally ran on the VA Ann Arbor Healthcare System website.