Provision of Assistive Technology to Veterans Post-Stroke

描述(由申请人提供)： 研究记录了残疾人口数量的增加、残疾人士使用AT的迅速增加、AT设备提供方面的差异以及影响不使用AT设备的因素。缺乏关于AT设备的功效、分布和影响的更深入的信息。对于临床医生在开出ATD时所涉及的决策过程的结果，即开了多少台设备，开给了谁，人们知之甚少。隔多长时间？代价是什么？该研究团队发现，VHA在提供AT设备方面存在显著的地域差异，这不能完全由人口统计、诊断和残疾严重程度等老兵因素来解释。“让退伍军人恢复功能独立的技术”(http://www.research.va.gov/)是退伍军人管理局的重点。同样重要的是考虑退伍军人将如何使用这项技术。过去的研究表明，ATDS的供应存在差异，这不能被退伍军人的需求所解释。拟议的研究将调查影响AT设备供应模式的VHA系统和工艺因素。拟议研究的结果将提供可用于制定指导方针的证据，以确保所有退伍军人，包括居住在农村地区的退伍军人，都能公平地获得技术。这将是一项对2006-07财年首次中风的退伍军人进行的回溯性、全国性、以人群为基础的研究。数据将从几个国家退伍军人管理局数据库中获得。本研究的具体目的是：(1)确定退伍军人VHA“结构”因素对“过程”因素和退伍军人“结果”因素的影响；(2)确定VHA“过程”因素对退伍军人“结果”--接受ATD的影响(S)。使用结构过程结果概念模型，目标1将使用多元回归分析来调查：(1a)VHA人员配备和设施复杂性、实施的AT评估和患者使用AT的培训之间的关系；(1b)VHA人员配备和设施类型以及和设备提供模式之间的关系。目标2将使用泊松回归分析来调查实施AT评估的次数和提供AT使用培训的次数和设备提供模式之间的关系。长期目标是：(1)制定基于证据的AT/假肢供应指南，涵盖诊断、残疾程度和设备类型，如活动设备、假肢等；(2)制定评估指南有效性的计划。

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.