During fiscal years 2000 and 2001, the Veterans Health Administration (VHA) provided veterans with more than 131,000 wheelchairs and scooters at a cost of $109 million. A national study was conducted to investigate Veterans Health Administration costs in providing wheelchairs and scooters and to compare regional prescription patterns.
Results showed that regionally, 71% to 86% of all wheelchairs provided were manual wheelchairs, 5% to 11% were power wheelchairs, and 5% to 20% were scooters. The considerable variation found in the types of wheelchairs and scooters provided across Veterans Integrated Service Networks indicated a need for evidence-based prescription guidelines and clinician training in wheeled mobility technologies.
As wheelchair technology becomes increasingly sophisticated and complex, so do decisions regarding who gets what wheelchair. These decisions are significant because manual and power wheelchairs and scooters were the second, third, and fifth highest prosthetics and sensory aids service spending totals, respectively, for the first three quarters of fiscal year 2000.
Because of rapid technological advances, many clinicians are making decisions about technology that did not exist when they received their training. Staying abreast of advances in wheeled mobility technology is challenging even for clinicians with seating and mobility expertise. Concurrently, demand for wheelchairs and scooters is increasing because of Operation Enduring Freedom and Operation Iraqi Freedom injuries, and an aging veteran population.
The first objective of the study was to identify regional patterns of wheelchair and scooter provision, e.g., whether more power wheelchairs are provided in some areas and more manual wheelchairs in others. The second objective was to describe the range in cost of specific wheelchairs and scooters.
The data described in the study did not produce clear patterns of provision, however, it supported geographic variation and suggested that, while some facilities within Veterans Integrated Service Networks may be overprescribing, others may be underprescribing.
The study concluded that as the availability of and demand for wheeled mobility devices increases, two important issues must be addressed:
- Policy or clinical guidelines must be established to allocate the devices equitably, and
- Clinicians must be kept up-to-date in their training on this rapidly changing technology.
The long-range goal of the research is the emergence of “best practices,” so that appropriate use and equity in the provision of devices and quality of care will prevail.