Date Presented 04/04/19
This poster will highlight a new model of low-vision rehabilitation service delivery that addresses the chronic nature of visual impairment, as well as the pilot roll-out. Data collected from key stakeholders, including individual factors (knowledge, skills), interpersonal (social environment), community (family and community supports), organizational (health and social systems), and public policy factors (reimbursement), will be illustrated and integration of data into the model will be discussed.
Primary Author and Speaker: Jennifer Kaldenberg
PURPOSE: For those with uncorrectable visual impairment (VI), there is much that can be done to support independence and quality of life (Rein, Wirth, Johnson, & Lee, 2007; Maciosek, Coffield, Flottemesch, Edwards, & Sloberg, 2010). Low vision rehabilitation services (LVRS) teach individuals with VI compensatory strategies, including visual skills training, assistive technology, and environmental modifications to participate in activities of daily living. In the U.S., there are currently no statewide comprehensive LVRS that serve both individuals who are blind and those with low vision. Services are often provided in a limited capacity and are often dependent upon financial resources, eligibility, and referral practices (Wittich, Canuto, & Overbury, 2013). Given these challenges, this research aimed to develop a new model of low vision rehabilitation service delivery for adults with VI.
METHODS: This study used a mixed method, convergent design approach. Focus groups (n=8) were conducted to understand consumer perspectives of barriers and facilitators in accessing LVRS. Focus groups were conducted with individuals with VI living in high and low resource communities. Those involved in the focus groups received a follow-up interview in which demographic data was collected, and participants were asked to identify and prioritize key barriers and facilitators to accessing LVRS. These prioritized barriers were used to identify differences between high and low resource communities. Demographic data were also analyzed to examine the relationship between demographic and service utilization factors and improved access to LVRS. Key stakeholder interviews (n=5) were conducted to understand additional perspectives on barriers and facilitators to accessing care. Data from focus groups and interviews were collected, themes were organized and merged, and integrated to inform model development.
RESULTS: Sixty-four adults (high resource (HR) = 30, low resource (LR) = 34) with self-reported VI participated in the focus groups. All focus group participants also participated in one-on-one follow-up interviews. In addition, five key stakeholders who work directly with individuals with VI participated in one-on-one interviews. The fourteen themes which emerged were organized to inform levels of the CCM as adapted for LVRS. Data from focus groups and key stakeholder interviews, as well as previous literature and established best practice guidelines were merged and applied to the CCM model. Themes related to public policy, community, and organizational levels were applied to the community and health systems level, as well as practice level of the CCM. Interpersonal and individual factors were applied to the practice level and productive interactions levels. Because VI is a chronic condition that requires ongoing service delivery, the Chronic Care Model was used as the new model’s framework, applying the existing Chronic Care Model to develop a LVR focused care delivery model.
CONCLUSION: As the majority of VIs are progressive and chronic, the use of the CCM may be an effective model for service delivery. Data from pilot implementation of the model will be provided. Collaboration between community and health systems, as well as case management, will assist in program sustainability and reach to all adults throughout the state living with VI.
IMPACT STATEMENT: This poster will describe the development and pilot of a new stakeholder-driven best practice model of LVRS that will provide a new structure for service delivery throughout the state of Massachusetts, led by OT.
References
Rein, D.B., Wirth, K.E., Johnson, C.A., & Lee, P.P (2007). Estimating quality-adjusted life year losses associated with visual field deficits using methodological approaches. Ophthalmic Epidemiology, 14(4), 258-264. doi:10.1080/01658100701473267
Maciosek, M.V., Coffield, A.B., Flottemesch, T.J., Edwards, N.M., & Sloberg, L.I. (2010). Greater use of preventative services in U.S. health care could save lives at little or no cost. Health Affairs, 36(7), 1656-1660. doi:10.1377/hlthaff.2008.0701
Wittich, W., Canuto, A., & Overbury, O. (2013). Overcoming barriers to low-vision rehabilitation services: Improving the continuum of care. Canadian Journal of Ophthalmology, 48(6), 463-467. doi:10.1016/j.jcjo.2013.05.013.
Wagner, E.H., Austin, B.T., Davis, C., Hindmarsh, M., Schafer, J., Bonomi, A. (2001). Improving chronic illness care: Translating evidence into action. Health Affairs, 20(6), 64-78.
