Biomedical subjects

Grace Warner

Publications and source records attributed to Grace Warner.

4 recordsLinked to original sources

PubMed2004

A pilot study of functional access to public buildings and facilities for persons with impairments.

PURPOSE: To compare functional access to public buildings and facilities for persons with and without impairments. METHOD: This is a cross-sectional pilot study with a survey design. A four-member participant team representing three impairment types: mobility impaired person using a wheelchair, mobility impaired person who was not a wheelchair user, visually impaired person, and a control with no known impairments, challenged a stratified random sample of 30 public buildings in Greater Boston. Using a task oriented data collection instrument, functional access was determined in terms of percentage of tasks performed, time, distance, barriers and facilitators. RESULTS: Overall, task performance was high for the team. However, the wheelchair user reported a lower task performance (81%) in comparison to the control (100%) and persons with mobility and visual impairments (97-98%). There was little variation in mean values for time and distance to complete tasks. More barriers were reported by the persons with mobility impairments, wheelchair user and non-wheelchair user, and; highest facilitators by the person with visual impairment and the wheelchair user. The control reported the lowest barriers and facilitators. The types of barriers and facilitators varied for the three impairments and the control structural for wheelchair and mobility impairments, wayfinding for visual impairment and interpersonal for control. CONCLUSIONS: Task performance by itself may not be a good predictor of functional access. Barriers and facilitators are critical to understanding issues related to functional access for persons with impairments. Knowledge of how these differ for different impairments can be useful for improving environmental access and rehabilitation.

Adult↗

PubMed2004

Evaluating diagnosis-based risk-adjustment methods in a population with spinal cord dysfunction.

OBJECTIVE: To examine performance of models in predicting health care utilization for individuals with spinal cord dysfunction. DESIGN: Regression models compared 2 diagnosis-based risk-adjustment methods, the adjusted clinical groups (ACGs) and diagnostic cost groups (DCGs). To improve prediction, we added to our model: (1) spinal cord dysfunction-specific diagnostic information, (2) limitations in self-care function, and (3) both 1 and 2. SETTING: Models were replicated in 3 populations. PARTICIPANTS: Samples from 3 populations: (1) 40% of veterans using Veterans Health Administration services in fiscal year 1997 (FY97) (N=1,046,803), (2) veteran sample with spinal cord dysfunction identified by codes from the International Statistical Classification of Diseases, 9th Revision, Clinical Modifications (N=7666), and (3) veteran sample identified in Veterans Affairs Spinal Cord Dysfunction Registry (N=5888). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Inpatient, outpatient, and total days of care in FY97. RESULTS: The DCG models (R(2) range,.22-.38) performed better than ACG models (R(2) range,.04-.34) for all outcomes. Spinal cord dysfunction-specific diagnostic information improved prediction more in the ACG model than in the DCG model (R(2) range for ACG,.14-.34; R(2) range for DCG,.24-.38). Information on self-care function slightly improved performance (R(2) range increased from 0 to.04). CONCLUSIONS: The DCG risk-adjustment models predicted health care utilization better than ACG models. ACG model prediction was improved by adding information.

Activities of Daily Living↗

PubMed2003

The impact of Internet access for people with spinal cord injuries: a descriptive analysis of a pilot study.

PURPOSE: A pilot study was undertaken regarding the effect of Internet access on health-related quality of life (HRQoL) and self-reported impact for people with spinal cord injuries (SCI). This study is unique in providing free Internet access and looking at benefits for people with disabilities. METHOD: HRQoL was measured using indicators of global health and social isolation at baseline and after 6 to 19 months of use via telephone interviews on a convenience sample of 23 adults with SCI. Additionally, monthly telephone surveys measured usage patterns, recreation, and self-reported impact. Both quantitative and qualitative analyses were conducted. Bivariate tests for differences in proportions and paired T-tests were conducted. Qualitatively, conceptual categories of impact were created using the Constant Comparative Method. RESULTS: Qualitatively, the predominant benefit was quality of life, mentioned by 61% of participants 46% of months surveyed, with quantitative trends towards improved emotional health. Ease of access to information, social connection, and quality of information were also frequently reported, with modest support from quantitative data. CONCLUSIONS: The study's persuasive qualitative results suggest the Internet has particular benefit to people with disabilities and that rehabilitation goals should include leisure. Further scientific research is strongly warranted.

Adolescent↗

PubMedDate not supplied

Factors associated with the successful implementation of a quality improvement project in human immunodeficiency virus ambulatory care clinics.

We examined a quality improvement (QI) program, offered to ambulatory care clinics (N = 82) serving human immunodeficiency virus-positive clients, to determine what factors predicted the clinic independently implementing QI processes without their program consultant's help. Initial analyses examined clinics at 4 levels of involvement: withdrew from the project, initial QI proficiency, advanced QI proficiency, and consultant independent. The initial and advanced stages were collapsed into 1 group (consultant dependent) and compared with consultant-independent clinics for multivariate logistic regression. In the multivariate models, 3 factors significantly predicted the clinic being consultant independent: staffing level (odds ratio [OR] = 1.6, 95% confidence interval [CI] = 1.2-2.2), the number of participating months (OR = 1.4, 95% CI = 1.0-2.0), and baseline QI readiness (OR = 1.1, 95% CI = 1.0-1.3). Receiver operator curves were calculated for significant predictors; the strongest predictor was staffing (c statistic = .79). Clinics that are organizationally prepared for QI, allow adequate time to adopt QI methods into their organization, and provide adequate QI staffing are more likely to independently apply QI methods.

Ambulatory Care Facilities↗