Effectiveness of the VA System at Providing Wheeled Mobility Devices

[摘要] A plethora of data has been collected documenting the need for assistive technology. There is little information however about the efficacy, distribution, and impact of assistive technology. Three related studies investigating demographic, cost, and health related quality of life (HRQoL) factors of the provision of wheelchairs and scooters were completed. The first investigated demographic and clinical differences. The second investigated differences in wheelchair costs among Veteran Integrated Service Networks (VISNS) and vendors. The third investigated the relationship between wheelchairs provided by the Veterans Health Administration (VHA) and HRQoL. Using a cross-sectional, retrospective study design, three years of data from VHA National Prosthetic Patient and National Patient Care yielding 191,324 observations. Databases, and one year of data from the SF-36V of the Veterans Health Study were merged. Descriptive statistics, t-test, chi-square, ANCOVA, ANOVA, and logistic regression were used to analyze the data. The first study found more evidence for differences between Hispanics and Caucasians than between African Americans and Caucasians. When comparing manual wheelchairs, Hispanics (Odds Ratio=1.7), African Americans (Odds Ratio =1.1), and American Indians & Asians (Odds Ratio =1.6) were more likely than Caucasians to receive depot wheelchairs, and Hispanics were more likely than Caucasians to receive ultralight chairs (Odds Ratio=1.8). When comparing power wheelchairs Hispanics (Odds Ratio=1.6) were more likely than Caucasians to receive custom power chairs. Older veterans were more likely to receive standard depot wheelchairs (p=<.0001) and younger veterans ultralight wheelchairs (p=<.0001). The most frequently prescribed wheelchairs for all diagnoses were the standard manual wheelchair (51%), the lightweight manual wheelchair (15%), and the scooter (14%). The second study found variation in cost by VISN and by vendor. During FY00 and FY01, of the $109 million spent by the VHA to provide over 131,000 wheelchairs and scooters, 7%, or $7,747,405 was considered excessive cost. The third study found veterans who received adjustable, ultralight manual wheelchairs had significantly lower physical function scores, as measured by the SF-36V, and significantly higher mental function, general health, and mental component summary scores than veterans who received nonadjustable, standard manual chairs, when adjusting for clinical and demographic factors.

[发布机构] the University of Pittsburgh

[效力级别] outcomes