Demographic and clinical variation in Veterans Health Administration provision of assistive technology devices to veterans poststroke.

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.

Cost, utilization, and policy of provision of assistive technology devices to veterans poststroke by Medicare and VA.

Background: The increase in provision of assistive technology devices (ATDs) has spurred controversy over Medicare policy aimed at reducing cost-policy that forces social isolation and conflicts with legislation, facilitating participation for individuals with disabilities. In contrast, Department of Veterans Affairs (VA) policy does not limit provision of AT to "in home" use only but rather, states "all enrolled and some non-enrolled veterans are eligible for all needed prosthetics."

Objectives: Examine ATD provision policy by comparing 2 systems, Medicare and VA.

Factors influencing decisions to admit patients to veterans affairs specialized rehabilitation units after lower-extremity amputation.

Unlabelled: Bates BE, Kwong PL, Kurichi JE, Bidelspach DE, Reker DM, Maislin G, Xie D, Stineman M. Factors influencing decisions to admit patients to Veterans Affairs specialized rehabilitation units after lower-extremity amputation.

Objective: To understand patient- and facility-level characteristics that influence decisions to admit veterans to a specialized rehabilitation unit (SRU) after a lower-extremity amputation.

Survival analysis in amputees based on physical independence grade achievement.

Background: Survival implications of achieving different grades of physical independence after lower extremity amputation are unknown.

Objectives: To identify thresholds of physical independence achievement associated with improved 6-month survival and to identify and compare other risk factors after removing the influence of the grade achieved.

Design: Data were combined from 8 administrative databases.

The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system.

Objective: To compare outcomes between lower-extremity amputees who receive and do not receive acute postoperative inpatient rehabilitation within a large integrated health care delivery system.

Design: An observational study using multivariable propensity score risk adjustment to reduce treatment selection bias.

Setting: Data compiled from 9 administrative databases from Veterans Affairs Medical Centers.

Distribution and cost of wheelchairs and scooters provided by Veterans Health Administration.

During fiscal years 2000 and 2001, the Veterans Health Administration provided veterans with more than 131,000 wheelchairs and scooters at a cost of $109 million. This national study is the first to investigate Veterans Health Administration costs in providing wheelchairs and scooters and to compare regional prescription patterns. With a retrospective design, we used descriptive methods to analyze fiscal years 2000 and 2001 National Prosthetics Patient Database data (cleaned data set of 113,724 records).

Factors associated with VHA costs of care for first 12 months after first stroke.

We examined the use patterns and costs of care for a validated stroke cohort (n = 172) from 13 Department of Veterans Affairs (VA) medical centers 1 year poststroke. Decision Support System (DSS) cost and use data (inpatient and outpatient) are profiled. We provide preliminary information about the costs associated with inpatient and outpatient care and explore the relationship between the cost of stroke care, location of service (inpatient and outpatient), and patient functional outcomes.

Clinical factors associated with prescription of a prosthetic limb in elderly veterans.

Objectives: To determine how advanced age influences prosthetic prescription.

Design: Retrospective cohort analysis with theory-driven logistic regression models. A Post Amputation Quality-of-Life (PAQ) framework of outcomes was proposed and empirically tested.

Risk factors associated with mortality in veteran population following transtibial or transfemoral amputation.

This study explored medical conditions associated with mortality among veterans following transfemoral amputation, transtibial amputation, or hip disarticulation. We applied logistic regression models to identify clinical factors associated with mortality postoperatively. The participants included patients with lower-limb amputations (n = 2,375) who were discharged from Veterans Health Administration hospitals between October 1, 2002, and September 30, 2003.

Demographic characteristics of veterans who received wheelchairs and scooters from Veterans Health Administration.

Little is known about the reasoning process clinicians use when prescribing wheeled mobility equipment (WME) or about the outcomes of this process, i.e., how many devices are prescribed, to whom, how often, and at what cost.

Assessing and using comorbidity measures in elderly veterans with lower extremity amputations.

Background: Understanding comorbidity prevalence and the effects of comorbidities in older veterans with lower extremity amputations may aid in assessing patient outcomes, resource use, and facility-level quality of care.

Objectives: To determine the degree to which adding outpatient to inpatient administrative data sources yields higher comorbidity prevalence estimates and improved explanatory power of models predicting 1-year mortality and to compare the Charlson/Deyo and Elixhauser comorbidity measures.

Methods: A retrospective cohort study applying frequencies, cross-tabulations, and logistic regression models was conducted, including data from 2,375 veterans with lower extremity amputations.

Multiple system utilization and mortality for veterans with stroke.

Background And Purpose: Many Veteran Health Administration (VHA) enrollees receive health services outside the VHA system. However, limited information is available about poststroke utilization and mortality by veterans who used multiple sources of health care. This study assessed the likelihood of 12-month poststroke rehospitalization and mortality of veterans who used VHA only versus those who used multiple sources of care.

Race/ethnicity: who is counting what?

Misclassification of race and ethnicity in administrative data may produce misleading results if it is overlooked or ignored. In this study, we examined the racial/ethnic classifications of 1,084 veterans with stroke in Florida who received inpatient and outpatient services within the Department of Veterans Affairs (VA) healthcare system and who were also eligible for Medicare between 2000 and 2001. We compared the reliability of racial/ethnic classifications between VA inpatient data, VA outpatient data, and Medicare data.

Development of an integrated stroke outcomes database within Veterans Health Administration.

A fundamental goal of the Rehabilitation Outcomes Research Center of Excellence is to improve care and outcomes for veterans with rehabilitation needs. To achieve this goal, the Center's primary objective is increasing research capacity. The Integrated Stroke Outcomes Database is a collection of Veterans Health Administration (VHA) clinical and administrative data containing patient information on a cohort of stroke patients found in the Functional Status Outcomes Database (FSOD), National Patient Care Database (NPCD), and other VHA sources.

Why ethnic designation matters for stroke rehabilitation: comparing VA administrative data and clinical records.

Using existing administrative data to look at issues of ethnic disparities in rehabilitation-related outcomes may lead to misleading results. Problems can emerge from apparently small issues of reliability that are magnified by reclassification of ethnic designation and missing data in complete-subject analyses. We compared the reliability of ethnic assignment in Department of Veterans Affairs (VA) medical rehabilitation records for stroke patients with administrative records; reclassified the racial identifier from the administrative data in two ways; and examined the different sources of ethnic information in relation to severity, length-of-stay, disability assessment, and discharge disposition.

Racial differences in use of colonoscopy, sigmoidoscopy, and barium enema in Medicare beneficiaries.

Colorectal cancer is often diagnosed at a later stage in blacks. We wanted to know if racial differences existed in the use of tests for detection of colorectal cancer. A 5% random sample was obtained of all Medicare beneficiaries with Part B coverage, aged 65 years and older and classified as white or black race.

Evaluation of proxy responses to the Stroke Impact Scale.

Background And Purpose: The purposes of this study were to compare proxy-patient responses on each domain of the Stroke Impact Scale (SIS) and the SIS-16, estimate the bias, and evaluate the validity of proxy scores.

Methods: Two hundred eighty-seven patient and proxy pairs from the Kansas City Stroke Registry participated in the study. All patients were assessed in their home or nursing facility between 90 and 120 days after stroke with the use of the modified Rankin Scale Motricity Index (strength), Barthel Index (activities of daily living), Lawton assessment (instrumental activities of daily living), Folstein Mini-Mental State Examination (cognition), and the SIS.

Structure, process, and outcomes in stroke rehabilitation.

Background: The health services research framework of structure, process, and outcome is used commonly to examine quality of care, and it indicates that structure influences process, which in turn influences outcomes. However, little empirical work has been done to test this hypothesis, particularly for medical rehabilitation.

Objectives: To determine if, among stroke patients, (1) structure of care was associated with process of care, and (2) structure of care was associated with outcomes after adjusting for process.

Performance of a mail-administered version of a stroke-specific outcome measure, the Stroke Impact Scale.

Objective: To evaluate the feasibility and concurrent validity of a new, mail-administered, stroke-specific outcome measure, the Stroke Impact Scale (SIS).

Design: Observational cohort study.

Setting And Patients: Stroke patients who had lived independently in the community prior to their stroke and who were candidates for post-stroke rehabilitation were recruited from nine, high-volume, Department of Veteran Affairs Medical Centers.

Co-morbidity adjustment for functional outcomes in community-dwelling older adults.

Objective: To characterize relationships between self-reported co-morbidity and functional outcomes in community-dwelling older adults, and to assess whether the impact of co-morbidity persists even after adjustment for baseline functional status.

Design: Prospective observational study. We examined associations between self-reported co-morbidity at baseline and functional outcomes at one year, with and without adjustment for baseline functional status.

Postacute stroke guideline compliance is associated with greater patient satisfaction.

Objective: To determine if the structure of care or the process of stroke care, as measured by compliance with stroke guidelines published by the Agency for Healthcare Research and Quality (AHRQ), is associated with patient satisfaction.

Design: Prospective inception cohort study of new stroke admissions including postacute care with follow-up interviews at 6 months poststroke.

Setting: Eleven Veterans Affairs medical centers (VAMCs).

The hazards of stroke case selection using administrative data.

Background: Administrative data and ICD-9-CM diagnostic codes are frequently used in research efforts to evaluate risk adjusted patient outcomes, particularly mortality. Varying ICD-9-CM sampling algorithms have been used to identify stroke patients.

Objectives: This study evaluates the effects of different sampling strategies (one high sensitivity and one high specificity) on modeling stroke mortality as a performance indicator.

Adherence to postacute rehabilitation guidelines is associated with functional recovery in stroke.

Background And Purpose: The purpose of this study was to determine if compliance with poststroke rehabilitation guidelines was associated with better functional outcomes.

Methods: An inception cohort of 288 stroke patients in 11 Department of Veteran Affairs Medical Centers hospitalized between January 1998 and March 1999 were followed prospectively for 6 months. Data were abstracted from medical records and telephone interviews.