Use of Focus Groups to Identify Knowledge Gaps About Care for Spinal Cord Injured Veterans

Legro M, Weaver FM, Hammond M. Use of Focus Groups to Identify Knowledge Gaps About Care for Spinal Cord Injured Veterans. Paper presented at: VA HSR&D National Meeting; 2000 Mar 1; Washington, DC.

Objectives: The Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI) is part of a VA effort to improve quality of health care for specific veteran populations. A primary QUERI goal is to identify areas of study that will yield improved quality of care. Since SCI is a permanent injury requiring acute, rehabilitative, preventive, and lifelong care, there are many interventions to review for effectiveness and for their relation to the patient's health-related quality of life. The purpose of convening focus groups was to identify areas where patients and providers have questions not addressed by existing research.Methods: Ten focus groups were convened, five with providers and five with patients at VA SCI Centers (GA, IL, NJ, WA, and WI). The resulting information was compiled and presented to the SCI QUERI Executive Committee (research and clinical experts) for consolidation into research topics. Results: Patient groups were 90% male and with appropriate representation by age, type of injury, and living situation. Most patients received acute care at a non-VA hospital with transfer to VA care. Provider groups included dietitians, health care technicians, home care coordinators, nurses, physical therapists, physicians, physician assistants, psychologists, rehabilitation therapists, and social workers. The major topics identified by SCI veterans were: pain, sexual functioning and fertility, shoulder overuse problems, equipment needs and access, housing and transportation issues, home care and nursing home care, issues related to caregiver training and caregiver burden, and access to providers with expertise in SCI. Providers mentioned many of the same issues (e.g., pain management, overuse injuries, and sexual functioning). However, providers also indicated areas such as substance abuse, nutrition, surgery for veterans with SCI, aging with SCI, and continued problems with managing and preventing pressure ulcers and urinary tract infections.Conclusions: Many topics are common to both SCI veterans and providers. Identified knowledge gaps will guide the formulation of new RFA/RFPs. One RFA has been disseminated on Pressure Ulcer Prevention and Management, and one is being developed on the Preoperative Risks and Outcomes of Surgery for Individuals with SCI.Impact: The identification of knowledge gaps will promote the generation and funding of RFAs by HSRandD for research of greatest need and priority to patients with SCI and providers of SCI care. Specific education and dissemination activities will also be formulated.