Understanding Quality and Equity in Wheelchairs for Veterans

了解退伍军人轮椅的质量和公平性

• 批准号: 8857410
• 负责人: Larissa Myaskovsky
• 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: 2010-07-01 至 2013-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8857410
• 关键词: African American; Age; Anxiety; Caring; Certification; Characteristics; Client satisfaction; Control Locus; Data; Data Analyses; Devices; Disabled Persons; Discrimination; Economics; Employment; Ethnic Origin; Gender; Health; Health Communication; Health Personnel; Healthcare; Home environment; Intervention; Interview; Knowledge; Limb structure; Low income; Mediating; Medical; Medical center; Mental Depression; Minority; Modeling; North America; Occupational; Outcome; Participant; Patients; Philadelphia; Play; Population; Process; Provider; Quality of life; Race; Recruitment Activity; Research; Risk; Role; Self Perception; Self-Help Devices; Services; Site; Social Work; Societies; Source; Spinal cord injury; Training; Veterans; Wheelchairs; abstracting; career; continuing medical education; demographics; disability; experience; health belief; health knowledge; health literacy; improved; low socioeconomic status; medical specialties; psychologic; psychosocial; racism; rehabilitation engineering; satisfaction; skills; social

DESCRIPTION (provided by applicant): PROJECT SUMMARY/ABSTRACT Wheelchairs enable Veterans to participate in home, employment, and social activities that might otherwise be inaccessible to them, thereby improving their quality of life (QOL). Despite VA's efforts to remove financial and other barriers to the provision of high quality wheelchairs to all Veterans, preliminary evidence suggests that disparities exist in the quality of wheelchairs prescribed to vulnerable (e.g., minority race/ethnicity, lower socioeconomic status) Veterans with Spinal Cord Injury (SCI) or amputated limbs (AL). This finding is concerning because patients who receive lower quality wheelchairs may be at risk for adverse physical, psychological, economic, and QOL outcomes. Mounting research demonstrates that patient psychosocial characteristics (e.g., medical mistrust, perceived discrimination, locus of control) and provider factors (e.g., demographics and training) are associated with disparities in healthcare processes and outcomes. However, for Veterans with SCI or AL, no studies to date have examined (a) what patient and provider factors are associated with the prescription of high quality wheelchairs, and (b) how these factors are associated with wheelchair quality and patient outcomes. The proposed cross-sectional, multi-site study of Veterans with SCI or AL who use a wheelchair as their primary source of mobility aims to determine whether: (1) patient demographic (e.g., race, SES) and psychosocial characteristics (e.g., medical mistrust, experience of discrimination) and provider factors (e.g., years of practice, certification, demographics) are associated with wheelchair quality; (2) wheelchair quality is associated with key patient outcomes, including satisfaction with medical care, QOL, amount of wheelchair activity, and participation in social and work-related activities; (3) patient and provider factors are independently associated with key patient outcomes including satisfaction with medical care, QOL, amount of wheelchair activity, and participation; and (4) the association of patient and provider factors with patient outcomes is explained by differences in wheelchair quality. Veterans with SCI or AL, who were prescribed their wheelchairs through the VA, will be recruited from the Philadelphia, PA, Cleveland, OH, Richmond, VA, and Bronx, NY VA Medical Centers to participate in an interview to assess their demographic characteristics, health information, psychosocial characteristics (including, experience of discrimination, perceived racism, medical mistrust, self-image, anxiety/depression, health beliefs, health literacy, and communication) and health-related outcomes (including wheelchair skills, satisfaction, QOL, participation). We will also assess amount of wheelchair activity using data logging devices, and determine wheelchair quality by its make and model. Data will also be collected from all health care providers involved in wheelchair provision for study participants. Provider factors will include demographics (e.g., race/ethnicity, age, gender), and specialty (i.e., MD/OT/PT). For Occupational and Physical Therapists, we will determine if they are certified by the Rehabilitation Engineering and Assistive Technology Society of North America. Years of practice since completion of medical training, number of chairs prescribed over the span of their career, what role each provider plays in the wheelchair provision process, as well as the number of continuing medical education (CME) credits and/or educational credit units (ECU) they have obtained in the past 3 years related specifically to wheelchairs, will also be assessed. Understanding the associations among the proposed patient characteristics and provider factors is an essential step toward developing tailored interventions, aimed at patients and providers, to improve the quality and equity of wheelchair service delivery for Veterans.

描述（由申请人提供）：

项目成果

Quality and Equity in Wheelchairs Used by Veterans.

退伍军人使用的轮椅的质量和公平性。

• DOI: 10.1016/j.apmr.2016.09.116
• 发表时间: 2017
• 期刊: Archives of physical medicine and rehabilitation
• 影响因子: 4.3
• 作者: Myaskovsky,Larissa;Gao,Shasha;Hausmann,LeslieRM;Bornemann,KelleeR;Burkitt,KellyH;Switzer,GalenE;Fine,MichaelJ;Phillips,SamuelL;Gater,David;Spungen,AnnM;Worobey,Lynn;Boninger,MichaelL
• 通讯作者: Boninger,MichaelL

How Are Race, Cultural, and Psychosocial Factors Associated With Outcomes in Veterans With Spinal Cord Injury?

• DOI: 10.1016/j.apmr.2016.12.015
• 发表时间: 2017-09-01
• 期刊: ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
• 影响因子: 4.3
• 作者: Myaskovsky, Larissa;Gao, Shasha;Boninger, Michael L.
• 通讯作者: Boninger, Michael L.