John A. Kairalla, Sandra L. Winkler, Hua Feng; Understanding the Provision of Assistive Mobility and Daily Living Devices and Service Delivery to Veterans After Stroke. Am J Occup Ther 2015;70(1):7001290020. https://doi.org/10.5014/ajot.2016.015768
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OBJECTIVE. The objective of this study was to determine whether facility-level, structural factors affect the provision of assistive devices and services.
DESIGN. A retrospective design was used. Activities of daily living and mobility-related devices were categorized into 11 types. Logistic regression models were performed for each type of device, controlling for patient-level and facility-level covariates.
RESULTS. Non–veteran-level factors significantly affect the provision of assistive devices, even after covariate adjustment. Increased rehabilitation clinician staffing by 1 full-time equivalent position was associated with increased provision odds of 1%–5% for 5 of 11 types of devices. Lower facility complexity was significantly associated with increased provision odds of 35%–59% for 3 types of devices and with decreased provision odds of 16%–69% for 3 types of devices.
CONCLUSION. System-level factors, in addition to patient need, significantly affect the provision of assistive devices. Provision guidelines could assist clinicians in making decisions about device provision.
Level 1 (high complexity/high patient risk): High levels of teaching, research, or both; high volume and patient risk; largest number and breadth of physician specialists; Level 3 and 4 intensive care units
Level 2 (medium complexity): Medium levels of teaching, research, or both; medium patient risk; Level 4 intensive care units
Level 3 (low complexity): Little or no teaching or research; low levels of patient complexity; lowest number of physician specialists per prorated person; Level 1 and 2 intensive care units.
System-level factors, in addition to patient need, significantly affect the provision of ADL and mobility-related devices.
Variance in the provision of assistive devices that is not related to individual patient needs can be addressed by clinician training.
Although rehabilitation clinicians typically receive training in the provision of assistive devices, not all devices are prescribed by rehabilitation therapists; therefore, occupational therapy practitioners may need to provide training for other clinicians.
Assistive device prescription should be standardized at the facility and geographic area levels, that is, for patients with identical clinical and functional needs and resources, device provision should be the same regardless of where they receive their care.
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