Larissa Myaskovsky1, Shasha Gao2, Leslie R M Hausmann3, Kellee R Bornemann3, Kelly H Burkitt2, Galen E Switzer3, Michael J Fine3, Samuel L Phillips4, David Gater5, Ann M Spungen6, Lynn Worobey7, Michael L Boninger7. 1. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA. Electronic address: larissa.myaskovsky@va.gov. 2. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA. 3. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA. 4. James A. Haley Veterans Hospital, Tampa, FL. 5. Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Pennsylvania State University Medical Center, Hershey, PA. 6. National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Departments of Medicine and Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY. 7. Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA; Human Engineering and Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
Abstract
OBJECTIVES: To assess in Veterans with spinal cord injury (SCI) or amputated limb (AL) the following: (1) patient demographics, medical factors, cultural and psychosocial characteristic by race; (2) wheelchair quality by race; and (3) the independent associations of patient race and the other factors with wheelchair quality. DESIGN: Cross-sectional cohort study. SETTING: Three Department of Veterans Affairs (VA) medical centers affiliated with academic medical centers. PARTICIPANTS: Eligible participants were Veterans with SCI or ALs (N=516); 482 of them completed the interview. Analyses were restricted to white and African American participants. Because there was no variation in wheelchair quality among AL patients (n=42), they were excluded from all but descriptive analyses, leading to a final sample size of 421. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Wheelchair quality as defined by the Medicare Healthcare Common Procedure Coding System. RESULTS: We found race differences in many of our variables, but not in quality for manual (odds ratio [OR]=.67; 95% confidence interval [CI], .33-1.36) or power (OR=.82; 95% CI, .51-1.34) wheelchairs. Several factors including age (OR=.96; 95% CI, .93-.99) and income (OR=3.78; 95% CI, 1.43-9.97) were associated with wheelchair quality. There were no significant associations of cultural or psychosocial factors with wheelchair quality. CONCLUSIONS: Although there were no racial differences in wheelchair quality, we found a significant association of older age and lower income with poorer wheelchair quality among Veterans. Efforts are needed to raise awareness of such disparities among VA wheelchair providers and to take steps to eliminate these disparities in prescription practice across VA sites. Published by Elsevier Inc.
OBJECTIVES: To assess in Veterans with spinal cord injury (SCI) or amputated limb (AL) the following: (1) patient demographics, medical factors, cultural and psychosocial characteristic by race; (2) wheelchair quality by race; and (3) the independent associations of patient race and the other factors with wheelchair quality. DESIGN: Cross-sectional cohort study. SETTING: Three Department of Veterans Affairs (VA) medical centers affiliated with academic medical centers. PARTICIPANTS: Eligible participants were Veterans with SCI or ALs (N=516); 482 of them completed the interview. Analyses were restricted to white and African American participants. Because there was no variation in wheelchair quality among ALpatients (n=42), they were excluded from all but descriptive analyses, leading to a final sample size of 421. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Wheelchair quality as defined by the Medicare Healthcare Common Procedure Coding System. RESULTS: We found race differences in many of our variables, but not in quality for manual (odds ratio [OR]=.67; 95% confidence interval [CI], .33-1.36) or power (OR=.82; 95% CI, .51-1.34) wheelchairs. Several factors including age (OR=.96; 95% CI, .93-.99) and income (OR=3.78; 95% CI, 1.43-9.97) were associated with wheelchair quality. There were no significant associations of cultural or psychosocial factors with wheelchair quality. CONCLUSIONS: Although there were no racial differences in wheelchair quality, we found a significant association of older age and lower income with poorer wheelchair quality among Veterans. Efforts are needed to raise awareness of such disparities among VA wheelchair providers and to take steps to eliminate these disparities in prescription practice across VA sites. Published by Elsevier Inc.
Authors: Mary Amanda Dew; Larissa Myaskovsky; Galen E Switzer; Andrea F DiMartini; Herbert C Schulberg; Robert L Kormos Journal: Psychol Med Date: 2005-08 Impact factor: 7.723
Authors: Serena MacDonald; Leslie R M Hausmann; Florentina E Sileanu; Xinhua Zhao; Maria K Mor; Sonya Borrero Journal: Med Care Date: 2017-09 Impact factor: 2.983