Provision of Assistive Technology to Veterans Post-Stroke

为中风后退伍军人提供辅助技术

• 批准号: 7999208
• 负责人: SANDRA L. WINKLER
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7999208
• 关键词: Accounting; Accreditation; Activities of Daily Living; Address; Affect; Area; Back; Body part; Caring; Characteristics; Client satisfaction; Clinical; Complex; Data; Databases; Development; Devices; Diagnosis; Durable Medical Equipment; Effectiveness; Enrollment; Expenditure; Eye; Funding; Future; Goals; Guidelines; Hand; Health; Healthcare Systems; Individual; Inequality; Laws; Light; Limb Prosthesis; Logistic Regressions; Manual wheelchair; Maps; Medicare; Modeling; Outcome; Outcome Measure; Oxygen; Patient Education; Patients; Pattern; Performance; Physical Medicine; Policies; Population Sizes; Powered wheelchair; Probability; Process; Prospective Studies; Prosthesis; Regression Analysis; Rehabilitation Research; Rehabilitation therapy; Research; Research Project Grants; Resources; Robotics; Self-Help Devices; Sensory Aids; Series; Services; Severities; Staff Work Load; Stroke; Structure; System; Technology; Testing; Time; Training; Travel; Variant; Veterans; Wheelchairs; Work; Workload; arm; assistive device/technology; base; cost; demographics; design; disability; evidence base; evidence based guidelines; foot; functional outcomes; geographic difference; health administration; improved; population based; post stroke; programs; prospective; rehabilitation service; research and development; rural area

DESCRIPTION (provided by applicant): Studies have documented the increasing size of the population with disabilities, the rapid increase in the use of AT by the individuals with disabilities, disparity in the provision of AT devices, and factors influencing non-use of AT devices. What is lacking is more in depth information about the efficacy, distribution, and impact of AT devices. Little is known about the outcomes of the decision process clinicians engage in when prescribing ATDs, i.e. How many devices are being prescribed and to whom? How often? At what cost? This research team has found significant geographic variation in the provision of AT devices by the VHA that cannot be fully explained by veteran factors such as demographics, diagnosis, and severity of disability. "Technology that gives veterans back functional independence" (http://www.research.va.gov/) is a focus of the VHA. Also important is consideration of how veterans will access the technology. Past research as shown variation in the provisionof ATDs that can not be accounted for by veteran need. The proposed research will investigate VHA system and process factors that can effect AT device provision patterns. Results of the proposed study will provide evidence that can be used to develop guidelines to insure that access to the technology is equitable for all veterans including those residing in rural areas. This will be a retrospective, national, population-based study of veterans who had their first stroke during FY 2006-07. Data will be acquired from several national VA databases. The specific aims of the proposed research are: (1) To determine the impact of VHA "structure" factors on "process" and veteran "outcome" factors and (2) To determine the impact of VHA "process" factors on the veteran "outcome" - receipt of ATD(s). Using the Structure Process Outcomes conceptual model, the Aim 1 will use multivariate regression analyses to investigate the relationship between: (1a) VHA staffing and facility complexity, AT assessments administered, and patient training in use of AT and (1b) VHA staffing and facility types and and device provision patterns. Aim 2 will use Poisson regression analyses to investigate the relationship between the number of AT assessments administered and times training in use of AT is provided and device provision patterns. The long terms objectives are: (1) To develop evidence-based AT/prosthetic provision guidelines across diagnoses and levels of disability and types of devices, e.g. mobility devices, artificial limbs, etc. and (2) To develop programs to evaluate the effectiveness of the guidelines. PUBLIC HEALTH RELEVANCE: Narrative Assistive technology can improve veterans' independence and quality of their lives. This study will investigate how many devices are being prescribed and to whom. The results of this study can assist in providing information for the appropriate use of resources with the intent of making assistive technology equally available to all veterans.

描述（由申请人提供）： 研究表明，残疾人口的规模不断扩大，残疾人使用AT的人数迅速增加，AT设备的提供存在差异，以及影响不使用AT设备的因素。缺乏的是关于AT设备的有效性、分布和影响的更深入的信息。关于临床医生在开ATD处方时所参与的决策过程的结果，即开了多少器械以及给谁开的，我们知之甚少。多久一次？代价是什么？该研究小组发现，VHA提供AT设备的地理差异很大，无法用人口统计学，诊断和残疾严重程度等退伍军人因素完全解释。“使退伍军人恢复功能独立性的技术”（http：//www.research.va.gov/）是退伍军人管理局的一个重点。同样重要的是考虑退伍军人将如何获得这项技术。过去的研究表明，ATDs的供应变化不能被退伍军人的需求所解释。拟议的研究将调查VHA系统和过程中的因素，可以影响AT设备提供模式。拟议研究的结果将提供证据，可用于制定指导方针，以确保所有退伍军人，包括居住在农村地区的退伍军人，都能公平地获得这项技术。这将是一个回顾性的，全国性的，以人群为基础的研究退伍军人谁有他们的第一次中风在2006-07财年。将从几个国家VA数据库中获取数据。拟议研究的具体目标是：（1）确定VHA“结构”因素对“过程”和退伍军人“结果”因素的影响，以及（2）确定VHA“过程”因素对退伍军人“结果”-ATD接收的影响。使用结构过程结局概念模型，目标1将使用多变量回归分析来调查以下之间的关系：（1a）VHA人员配备和设施复杂性、管理的AT评估和患者AT使用培训，以及（1b）VHA人员配备和设施类型和器械供应模式。目的2将使用泊松回归分析研究AT评估次数和AT使用培训次数与器械供应模式之间的关系。长期目标是：（1）制定基于证据的AT/假肢提供指南，包括诊断和残疾程度以及设备类型，例如移动设备，假肢等;（2）制定评估指南有效性的计划。 公共卫生相关性： 叙事辅助技术可以提高退伍军人的独立性和生活质量。本研究将调查处方器械的数量和处方对象。这项研究的结果可以帮助提供信息，使辅助技术平等地提供给所有退伍军人的意图，资源的适当使用。