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2023 HSR&D/QUERI National Conference Abstract

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1085 — The Impact of Travel Distance and Veteran Characteristics on SCI/D Annual Evaluation Receipt

Lead/Presenter: Bridget Smith,  COIN - Hines
All Authors: Smith BM (COIN- Hines), Sippel JL (National Spinal Cord Injuries and Disorders System of Care National Program Office (11SCID) Evans CT (Center for Innovation of Complex Chronic Care, Hines IL) Huo Z (Center for Innovation of Complex Chronic Care, Hines IL) Etingen B (Center for Innovation of Complex Chronic Care, Hines IL) Willenberg R (VA Boston Healthcare System) Stroupe KT (Center for Innovation of Complex Chronic Care, Hines IL)

Objectives:
To address the diverse healthcare needs of Veterans with spinal cord injuries and disorders (SCI/D), the SCI/D System of Care offers a comprehensive Annual Evaluation (AE). An AE can include physical exams, preventive care services for common complications that are secondary to SCI/D (e.g., pain, spasticity, bowel and bladder complications, skin monitoring), and consultations for equipment. The objective of this analysis was to examine the association of travel distance and other Veteran characteristics with receipt of SCI/D AEs.

Methods:
As part of an HSRandD funded Research to Impact for VeteRans (RIVR) project, we leveraged VA administrative data from the VA SCI/D Registry and the Corporate Data Warehouse in FY2019 and FY2020 for Veterans with SCI/D. Travel distance was defined as distance from a Veterans home to a VA SCI/D Center/Hub (25 VA SCI/D Center/Hubs across the U.S.). We used multiple Poisson regression models to examine the association between Veteran characteristics, travel distance, and participation in 0, 1 or 2 AEs in the time period.

Results:
A total of 14,662 Veterans with SCI/D were included in the 2-year period, 32.8% (4,811) received two AEs; 28.8% (4,219) received one and 38.4% (5,632) received zero. Veterans who lived ? 240 minutes away from an SCI/D Center received 45% fewer AEs compared to Veterans who lived ? 30 minutes away (Adjusted RR: 0.55, 95% CI: 0.52–0.59). Veterans who had some post-secondary training received more AEs compared to Veterans with a high school education or less in adjusted (Adjusted RR: 1.07, 95%CI: 1.02–1.10) analyses. Race and ethnicity were also significantly associated with AE receipt. African American Veterans had 8% more AEs compared to white Veterans (Adjusted RR: 1.08, 95%CI: 1.04–1.12); unadjusted results were similar. Before adjusting for other characteristics, Native American Veterans had relatively fewer AEs compared to other Veterans, (RR = 0.71, 95%CI: 0.5 – 0.89), however, there was no significant difference in the adjusted model. There were no significant differences in AE receipt between Veterans who were Asian or Pacific Islander and other Veterans. Hispanic Veterans had more AEs in unadjusted analysis (RR: 1.13, 95%CI: 1.05–1.20), but after adjusting for other characteristics, Hispanic Veterans had 8% fewer AEs relative to other Veterans (Adjusted RR = 0.92, 95%CI: 0.86–1.19). Veterans in the highest quartile of outpatient visits in VA primary care outside of the SCI system of care had 28% fewer AEs than those in the lowest quartile (Adjusted RR: 0.72, 95% CI: 0.69 – 0.76).

Implications:
Over one-third of Veterans did not receive AEs in FY2019 or FY2020. Additional strategies are needed to address travel barriers to attending AEs. Small AE access disparities could be present for Native American and Hispanic Veterans, while Black Veterans access more AE services than white Veterans.

Impacts:
Individuals with SCI/D have substantial health care needs, however, use of the VHA AE remains low. Developing tailored interventions to increase the receipt of AEs, including further minimizing travel barriers, could potentially decrease SCI/D related complications, enhancing quality of life for Veterans with SCI/D and decreasing costs to the VA.