Luz M Semeah1, Tatiana Orozco1, Xinping Wang1, Mi Jung Lee1, Zaccheus James Ahonle1, Diane C Cowper Ripley1, Shanti P Ganesh1, Eric R Litt1, Lauren K Wilson1, Deepthi Satheesa Varma1, Huanguang Jia1. 1. is Principal Investigator and a Health Science Specialist; is a Health Science Specialist; and are Coinvestigators at the Veterans Rural Health Resource Center-GNV; is a Statistician in Research Services; is a retired Research Health Scientist; serves as the Methodologist (for this project); and is a Health Service Research Consultant; all at the North Florida/South Georgia Veteran Health System, Gainesville, Florida. is a Physical Medicine and Rehabilitation Physician at the Charlie Norwood VA Medical Center in Augusta, Georgia. Diane Cowper Ripley is Director Emeritus; is a Health Science Specialist and GIS Analyst; is a Geographer at the GeoSpatial Outcomes Division, US Department of Veterans Affairs Office of Rural Health. Mi Jung Lee is an Assistant Professor at the University of Texas Medical Branch at Galveston in Texas; Zaccheus Ahonle is an Assistant Professor in the Department of Counseling, Educational Psychology and Foundations at Mississippi State University. Shanti Ganesh is a Courtesy Clinical Assistant Professor in the Department of Occupational Therapy, College of Public Health and Health Professions and Deepthi Satheesa Varma is an Assistant Professor in the Department of Epidemiology at the University of Florida.
Abstract
BACKGROUND: Appropriate home modifications (HMs) can make the home environment accessible and relatively safe by reducing the risk of falls. Of special concern are individuals living alone, living in rural communities, and/or living in substandard housing. The Home Improvements and Structural Alterations (HISA) is a Veterans Health Administration (VHA) benefit program providing HMs for veterans with disabilities. METHODS: The objective of this study was to detail the profile of rural veteran (RV) HISA users and report on national HISA utilization patterns. We compare use at US Department of Veterans Affairs (VA) medical centers of varying complexity levels, and in VA regions. An examination of the relationship between travel time/distance and HISA utilization is also provided. This retrospective database study uses GeoSpatial analyses and 3 VA sources: The National Prosthetics Patient Database, the VHA Medical Inpatient Dataset, and the VHA Outpatient Dataset. RESULTS: From 2015 through 2018, 10,810 RVs used HISA with a mean age of 70.9 years. A majority of participants were White (79.5%), married (74.3%), and male (96.5%) veterans. They traveled a mean of 79.8 miles for 94.5 minutes to reach a facility where they received a HISA prescription. Nearly 75% of HISA users were able to receive a HISA prescription from their nearest facility, while about one-quarter traveled to a facility farther away, of which 43% travelled between 100 and 200 miles to obtain the HISA benefit. The top categories of diagnoses were musculoskeletal (19.1%), neurologic (12.5%), and cardiovascular (5.4%). There were about 11,166 HM prescriptions afforded to rural HISA users during the period, including bathroom (82.4%), doorway (4.9%), and railing (3.6%) modifications. CONCLUSIONS: This study documents the national demographics and clinical characteristics of rural HISA users, data that may be useful to policy makers, HM service providers and advocate as well as HISA administrators in predicting future use and users.
BACKGROUND: Appropriate home modifications (HMs) can make the home environment accessible and relatively safe by reducing the risk of falls. Of special concern are individuals living alone, living in rural communities, and/or living in substandard housing. The Home Improvements and Structural Alterations (HISA) is a Veterans Health Administration (VHA) benefit program providing HMs for veterans with disabilities. METHODS: The objective of this study was to detail the profile of rural veteran (RV) HISA users and report on national HISA utilization patterns. We compare use at US Department of Veterans Affairs (VA) medical centers of varying complexity levels, and in VA regions. An examination of the relationship between travel time/distance and HISA utilization is also provided. This retrospective database study uses GeoSpatial analyses and 3 VA sources: The National Prosthetics Patient Database, the VHA Medical Inpatient Dataset, and the VHA Outpatient Dataset. RESULTS: From 2015 through 2018, 10,810 RVs used HISA with a mean age of 70.9 years. A majority of participants were White (79.5%), married (74.3%), and male (96.5%) veterans. They traveled a mean of 79.8 miles for 94.5 minutes to reach a facility where they received a HISA prescription. Nearly 75% of HISA users were able to receive a HISA prescription from their nearest facility, while about one-quarter traveled to a facility farther away, of which 43% travelled between 100 and 200 miles to obtain the HISA benefit. The top categories of diagnoses were musculoskeletal (19.1%), neurologic (12.5%), and cardiovascular (5.4%). There were about 11,166 HM prescriptions afforded to rural HISA users during the period, including bathroom (82.4%), doorway (4.9%), and railing (3.6%) modifications. CONCLUSIONS: This study documents the national demographics and clinical characteristics of rural HISA users, data that may be useful to policy makers, HM service providers and advocate as well as HISA administrators in predicting future use and users.
Authors: Diane C Cowper Ripley; Pui L Kwong; W Bruce Vogel; Jibby E Kurichi; Barbara E Bates; Claire Davenport Journal: Med Care Date: 2015-06 Impact factor: 2.983
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