Low Vision Devices and Rehabilitation Services

描述（申请人提供）：最近完成的VA低视力干预试验（LOVIT）提供了第一个高质量的证据，证明低视力康复是非常有效的。最大的影响是对阅读能力的影响，大约是在私营低视力诊所服务的患者的观察性研究中看到的效应量的7倍。即使没有提供定向和活动（O&M）指导，LOVIT患者在活动方面也表现出显著的改善，这在私营部门的患者中没有观察到。退伍军人管理局和私营部门在低视力康复方面的一个主要区别是，退伍军人管理局支付低视力设备和广泛培训的费用，而医疗保险和其他医疗保险公司不支付低视力设备的费用，他们对培训的覆盖范围有限。针对VA和Medicare覆盖政策的差异，目前拟建的项目将计划一项多中心随机对照试验，以衡量第三方低视力设备覆盖和O&M指导对低视力康复结果的影响。采用定性研究方法，我们建议在参与中心的临床医生中引出并建立共识，以制定低视力康复的常规护理指南。我们将为一项3x2分层设计、多中心、随机对照试验计划并撰写详细的操作和程序手册，以测量以患者为中心的低视力康复结果；衡量服务和设备的成本效益、成本效用和需求弹性；通过成本覆盖政策的变化来衡量医疗计划的变化。

DESCRIPTION (provided by applicant): The recently completed VA Low Vision Intervention Trial (LOVIT) provided the first high quality evidence that low vision rehabilitation is extremely effective. The largest effect was for reading ability, which is approximately 7 times the effect size seen in observational studies of patients served by private sector low vision clinics. Even though orientation and mobility (O&M) instruction was not provided, LOVIT patients also exhibited a significant improvement in mobility, an improvement not observed in private sector patients. A major difference in low vision rehabilitation between the VA and private sector is that the VA covers costs of low vision devices and extensive training, whereas Medicare and other health care insurers do not cover the costs of low vision device and their coverage of training is limited. Focusing on the differences between VA and Medicare coverage policies, the presently proposed project will plan a multicenter randomized controlled trial to measure the effects of 3rd party coverage of low vision devices and O&M instruction on the outcome of low vision rehabilitation. Using qualitative research methods, we propose to elicit and build a consensus among participating center clinicians on usual care guidelines for low vision rehabilitation. We will plan and write a detailed Manual of Operations and Procedures for a 3x2 stratified design, multicenter, randomized controlled trial that measures patient-centered low vision rehabilitation outcomes; measures cost-effectiveness, cost-utilities, and demand elasticity of services and devices; and measures changes in plans of care with changes in cost coverage policies.