Demographic and Clinical Variation in Veterans Health Administration Provision of Assistive Technology Devices to Veterans Poststroke

Authors

Sandra L. Hubbard Winkler, Veterans Health System
Diane C. Cowper Ripley, Veterans Health System
Samuel Wu, Veterans Health System
Dean M. Reker, Edward Hines Jr Veterans Affairs Medical Center
Bruce Vogel, Veterans Health System
Shirley G. Fitzgerald, James A. Haley Medical Center
William C. Mann, College of Public Health and Health Professions
Helen Hoenig, Duke University

Date of this Version

2010

Citation

Arch Phys Med Rehabil 2010;91:369-77; doi:10.1016/j.apmr.2009.10.028

Abstract

Objectives: To examine variation in provision of assistive technology (AT) devices and the extent to which such variation may be explained by patient characteristics or Veterans Health Administration (VHA) administrative region.

Design: Retrospective population-based study.

Setting: VHA.

Participants: Veterans poststroke in fiscal years 2001 and 2002 (N=12,046).

Interventions: Not applicable.

Main Outcome Measure: Provision of 8 categories of AT devices.

Results: There was considerable regional variation in provision of AT. For example, differences across administrative regions in the VHA ranged from 5.1 to 28.1 standard manual wheelchairs per 100 veterans poststroke. Using logistic regression, with only demographic variables as predictors of standard manual wheelchair provision, the c statistic was .62, and the pseudo R² was 2.5%. Adding disease severity increased the c statistic to .67 and the pseudo R² to 6.2%, and adding Veteran Integrated Network System further increased the c statistic to .72 and pseudo R² to 9.8%.

Conclusions: Our research showed significant variation in the provision of AT devices to veterans poststroke, and it showed that patient characteristics accounted for only 6.2% of the variation. VHA administrative region and disability severity accounted for equivalent amounts of the variation.