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.