Event Title

WHO GETS WHICH WHEELCHAIR OR OTHER ASSISTIVE DEVICE: USER VERSUS FACILITY PREDICTORS

Location

Atrium

Start Date

14-2-2014 12:00 AM

Description

Objective. To use Donebedian's Structure-Process-Outcome Model to investigate Structure* (facility-level) and Process (assistive technology (AT) services) factors on assistive technology device (ATD) prescription (Outcome), controlling for individual-level factors. *Only structure results are presented. Background. ATDs enhance the independence and quality of life of individuals with disabilities. AT research is challenging because both individual needs and properties of device must be considered. This research looks at ATD provision from multiple perspectives: device, service, individual and facility-level factors. Our prior research found that geographic, small area variation was as strong a predictor of ATD prescription as individual-user need. Methods. A retrospective, population-based (Veterans) design was used. Records from the Functional Status Outcomes Database, National Prosthetic Patient Database, and Medical SAS Datasets for Veterans treated by the VA for stroke during 2007-08 were merged. Logistic regression was performed for each of the 11 types of activities of daily living and mobilityrelated ATDs. The predictor variables were facility complexity, CARF certification, rehabilitation staffing in FTE, and rehabilitation workload in encounters. The outcome variable was provision of ATDs. Results. Facility-level factors were significant for some but not all types of ATDs. Hispanics, blacks were more likely to receive standard manual wheelchairs, patient lifts, beds, toileting and bathing devices. Veterans who were prescribed ATDs typically had lower physical function but higher cognitive function. C-statistics ranged from 0.66 to 0.79; pseudo r2 ranged from 0.01 to 0.09; max-rescaled r2 ranged from 0.08 to 0.15. Conclusion. User-need alone does not determine ATD prescription. Facility-level factors, in addition to individual factors, are significant predictors of some types of ATDs prescribed by the VA. Grants. This research was funded by the VA Rehabilitation Research and Development(Merit Review B7168-R). The views and opinions expressed in this poster reflect those of the authors and do not necessarily reflect those of the VA.

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Feb 14th, 12:00 AM

WHO GETS WHICH WHEELCHAIR OR OTHER ASSISTIVE DEVICE: USER VERSUS FACILITY PREDICTORS

Atrium

Objective. To use Donebedian's Structure-Process-Outcome Model to investigate Structure* (facility-level) and Process (assistive technology (AT) services) factors on assistive technology device (ATD) prescription (Outcome), controlling for individual-level factors. *Only structure results are presented. Background. ATDs enhance the independence and quality of life of individuals with disabilities. AT research is challenging because both individual needs and properties of device must be considered. This research looks at ATD provision from multiple perspectives: device, service, individual and facility-level factors. Our prior research found that geographic, small area variation was as strong a predictor of ATD prescription as individual-user need. Methods. A retrospective, population-based (Veterans) design was used. Records from the Functional Status Outcomes Database, National Prosthetic Patient Database, and Medical SAS Datasets for Veterans treated by the VA for stroke during 2007-08 were merged. Logistic regression was performed for each of the 11 types of activities of daily living and mobilityrelated ATDs. The predictor variables were facility complexity, CARF certification, rehabilitation staffing in FTE, and rehabilitation workload in encounters. The outcome variable was provision of ATDs. Results. Facility-level factors were significant for some but not all types of ATDs. Hispanics, blacks were more likely to receive standard manual wheelchairs, patient lifts, beds, toileting and bathing devices. Veterans who were prescribed ATDs typically had lower physical function but higher cognitive function. C-statistics ranged from 0.66 to 0.79; pseudo r2 ranged from 0.01 to 0.09; max-rescaled r2 ranged from 0.08 to 0.15. Conclusion. User-need alone does not determine ATD prescription. Facility-level factors, in addition to individual factors, are significant predictors of some types of ATDs prescribed by the VA. Grants. This research was funded by the VA Rehabilitation Research and Development(Merit Review B7168-R). The views and opinions expressed in this poster reflect those of the authors and do not necessarily reflect those of the VA.