title: Quality and Equity in Wheelchairs Used by Veterans.
abstract: To assess in Veterans with spinal cord injury (SCI) or amputated limb (AL) the following: (1) patient demographics, medical factors, cultural and psychosocial characteristic by race; (2) wheelchair quality by race; and (3) the independent associations of patient race and the other factors with wheelchair quality.
  
  
  
  Cross-sectional cohort study.
  
  
  
  Three Department of Veterans Affairs (VA) medical centers affiliated with academic medical centers.
  
  
  
  Eligible participants were Veterans with SCI or ALs (N=516); 482 of them completed the interview. Analyses were restricted to white and African American participants. Because there was no variation in wheelchair quality among AL patients (n=42), they were excluded from all but descriptive analyses, leading to a final sample size of 421.
  
  
  
  Not applicable.
  
  
  
  Wheelchair quality as defined by the Medicare Healthcare Common Procedure Coding System.
  
  
  
  We found race differences in many of our variables, but not in quality for manual (odds ratio [OR]=.67; 95% confidence interval [CI], .33-1.36) or power (OR=.82; 95% CI, .51-1.34) wheelchairs. Several factors including age (OR=.96; 95% CI, .93-.99) and income (OR=3.78; 95% CI, 1.43-9.97) were associated with wheelchair quality. There were no significant associations of cultural or psychosocial factors with wheelchair quality.
  
  
  
  Although there were no racial differences in wheelchair quality, we found a significant association of older age and lower income with poorer wheelchair quality among Veterans. Efforts are needed to raise awareness of such disparities among VA wheelchair providers and to take steps to eliminate these disparities in prescription practice across VA sites.
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA. Electronic address: larissa.myaskovsky@va.gov.
authors.forename: Larissa
authors.initials: L
authors.lastname: Myaskovsky
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
authors.forename: Shasha
authors.initials: S
authors.lastname: Gao
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
authors.forename: Leslie R M
authors.initials: LRM
authors.lastname: Hausmann
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
authors.forename: Kellee R
authors.initials: KR
authors.lastname: Bornemann
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Burkitt
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
authors.forename: Galen E
authors.initials: GE
authors.lastname: Switzer
authors.affiliation: Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.affiliation: James A. Haley Veterans Hospital, Tampa, FL.
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Phillips
authors.affiliation: Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Pennsylvania State University Medical Center, Hershey, PA.
authors.forename: David
authors.initials: D
authors.lastname: Gater
authors.affiliation: National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Departments of Medicine and Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Spungen
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA; Human Engineering and Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Worobey
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA; Human Engineering and Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Boninger
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000671:Amputation, Surgical / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D011211:Electric Power Supplies; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D008297:Male; D011787:Quality of Health Care / Q000592:standards*; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D014481:United States; D014728:Veterans; D014910:Wheelchairs / Q000592:standards*; D044465:White People
keywords: Healthcare disparities; Rehabilitation; Spinal cord injuries; Wheelchairs