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2023 HSR&D/QUERI National Conference Abstract

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4072 — Veteran Perceptions of the SCI/D Annual Evaluation

Lead/Presenter: Bridget Smith,  COIN - Hines
All Authors: Smith BM (COIN-Hines), Sippel JL (Spinal Cord Injuries and Disorders System of Care National Program Office (11SCID) Etingen B (Coin Hines VA) Evans CT (Coin Hines VA) Kale I (Coin Hines VA) Escudero G (Coin Hines VA) Huo Z (Coin Hines VA) Willenberg R (VA Boston Healthcare System) Stroupe KT

Objectives:
The Veterans Health Administration (VHA) is the largest system of care for individuals with spinal cord injuries and disorders (SCI/D) in the world. Individuals with SCI/D require medical care to address mobility issues, as well as complications secondary to injury including pressure injuries, pain, bowel and bladder dysfunction, impaired respiratory function, and decreased psychosocial wellness. To address the needs of Veterans with SCI/D, VHA offers a comprehensive Annual Evaluation (AE). An AE can include physical exams and preventive care services for common complications that are secondary to injury. Despite the importance of prevention, as well as managing complications that result from SCI/D, only 45% of Veterans with SCI/D who receive VHA care had an AE in 2021. The objective of this quality improvement project was to collect data about Veterans’ perceptions of the AE to inform the development of an intervention to increase AE receipt.

Methods:
To examine Veterans’ perceptions of the AE, we conducted an online survey using the Qualtrics platform. We identified approximately 8,000 Veterans with VA email addresses and sent them an email invitation to participate. Paper surveys were also mailed to 300 Veterans who did not have a VA email address. Two reminder emails were sent to non-respondents to facilitate response. Survey questions included date and location of AEs, perceptions about the value of AEs, perceived barriers to receiving an AE, and preferences about AE delivery. Overall response rate was approximately 22%. We used frequencies to describe the results.

Results:
After excluding participants with missing data,1,573 Veterans were included in the analyses. Most participants (91%) were male. Mean participant age was 65, and 13% were African American and 5% were Hispanic. Of note, 90% of Veterans rated their satisfaction with the AE as excellent, very good, or good; 81% agreed or strongly agreed that the AE meets their urgent medical needs; and 80% indicated that the AE is important for their health and well-being. For Veterans who do not receive an AE every year, the most common barriers to receiving an AE were reported to be COVID-19 (58%), not being offered an AE (17%), and travel barriers (14%). Most Veterans preferred to receive their AE in-person (67%), and most (83%) Veterans indicated it was very important to receive care from an SCI/D specialty physician.

Implications:
The majority of respondents expressed high levels of satisfaction with the AE and found many aspects of the AE to be valuable. Additional strategies are needed to address travel barriers and access challenges that resulted from the pandemic to bolster AE receipt among Veterans with SCI/D.

Impacts:
Veterans with SCI/D generally regard the AE as valuable and important for their health, but barriers arising from the COVID-19 pandemic and from travel need to be further mitigated for more Veterans to take advantage of their AE.