The development and integration of a measure of rehabilitation outcomes into DVA Blind Rehabilitation Service
 
William R. De l’Aune, Ph.D. Michael William, M.S.
 
Rehabilitation R&D Center of Excellence, Atlanta VA Medical Center
 
Objectives: This project sought to develop a self-report, functional independence measure developed in previously completed Department of Veterans Affairs (DVA) projects is now being integrated into the service delivery system for the measurement of outcomes of blind rehabilitation programs in the Department of Veterans Affairs.
 
Methods: Benchmark data were gathered from visually impaired veterans who received rehabilitation services from the DVA from fiscal year 1997 through 2000. Data were also gathered during this period from a companion sample of 740 visually impaired non-veterans who received services from non-DVA rehabilitation facilities. Phone interviews were employed using the following core measures: Blind Rehabilitation Service Follow-up Outcome Survey (BRSFOutSur) measuring self-reported functional performance, Blind Rehabilitation Service Data Base (BRSDBase) recording subject characteristics, and Blind Rehabilitation Service Satisfaction Survey (BRSSatSur) measuring satisfaction with the rehabilitation process. These instruments are now being applied to all veterans undergoing rehabilitation at the ten blind rehabilitation centers in the DVA health care system. In addition, 3,000 veterans meeting the criteria for legal blindness but not undergoing rehabilitation are being surveyed on an annual basis to develop a baseline of function in this population. These benchmark data will be used to evaluate different models of service delivery in the context of veteran characteristics in order to provide data-based support in the development of clinical algorithms for case managers.
 
Results: As of October 31, 2000, data from 4,201 veterans have been collected for the demographic instrument, 2,682 veterans for the functional outcomes instrument, and from 3,270 veterans for the satisfaction instrument. This information was employed for establishing the psychometric properties of the instrument, reducing its length, and creating Rasch scaled scoring protocols. Reports on outcomes measured by functional change in BRSFOutSur scores and on patient satisfaction as measured by BRSSatSur are being provided on a quarterly basis to DVA HQ as part of VISN directors’ performance objectives and as part of CARF accreditation of the individual Blind Rehabilitation Centers. DVA Information Technology is developing software to allow national roll-up to the Decatur Rehab R&D Center of demographic and annual BRSFOutSur survey data from the 97 DVA Medical Centers with Visual Impairment Service Team Coordinators.
 
Conclusions: Data collection and analysis are continuing as part of DVA Blind Rehabilitation Service program evaluation. These findings and the further development of outcome instruments in this area will contribute to greater efficiency and effectiveness of the delivery of blind rehabilitation services by the Department of Veterans Affairs. The amount of positive functional change in clients served by Blind Rehabilitation Services has steadily increased over the last five years.
 
Funding Acknowledgment: Development of the instruments used in this research was supported by VA Rehab R&D grants C1776R and C1894R. Current work is being supported by VA Rehab R&D grant C2269R.