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. 2022 Jun;39(6):274-280.
doi: 10.12788/fp.0279. Epub 2022 Jun 16.

Predictors of County-Level Home Modification Use Across the US

Luz M Semeah  1 , Tatiana Orozco  1 , Xinping Wang  1 , Huanguang Jia  1 , Mi Jung Lee  1   2 , Lauren K Wilson  1 , Shanti P Ganesh  1   3 , Zaccheus J Ahonle  1   4 , Deepthi Satheesa Varma  1   3 , Eric R Litt  1 , Justin Kilkenny Ahern  1 , Leslie M Santos Roman  1   5 , Diane C Cowper Ripley  1
Affiliations

Predictors of County-Level Home Modification Use Across the US

Luz M Semeah et al. Fed Pract. 2022 Jun.

Abstract

Background: Geospatial analyses illustrating where the Home Improvements and Structural Alterations program (HISA) have been prescribed suggest that home modification (HM) services under US Department of Veterans Affairs (VA) is not prescribed and used uniformly across the US.

Methods: The objective of this study was to identify county characteristics associated with HISA use rates, such as county-level measures of clinical care and quality of care, variables related to physical environment, and sociodemographic characteristics. Multiple regression analysis was used to predict county-level utilization rate from county-level variables.

Results: County-level HISA use was highly skewed and ranged from 0.09 to 59.7%, with a mean of 6.6% and median of 5%. Percent uninsured adults and rate of preventable hospital stays emerged as significant predictors of county-level HISA utilization rate. Specifically, county percentage of uninsured adults was negatively related to county-level HISA utilization rate (b = -8.99, P = .005). The higher the proportion of uninsured adults the lower the HISA utilization rate. The county rate of preventable hospital stays was positively related to county-level HISA utilization rate (b = .0004, P = .009). County-level predictors of housing quality were not significantly associated with county-level HISA utilization rate.

Conclusions: Our research fills a gap in the literature about the impact of county-level variables and the geographic distribution and use of HISA. More research is needed to understand and account for geographical variation in HISA use. This work serves as a first step at quantifying and predicting HISA utilization rate at a broad level, with the goal of increasing access to HMs for veterans with disabilities.

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Conflict of interest statement

Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.

Figures

FIGURE 1
FIGURE 1
Total Home Improvements and Structural Alterations Users by County, Fiscal Years 2015 to 2018
FIGURE 2
FIGURE 2
County-Level HISA Utilization Rate per 1000 VHA FY 2015 Patients Histogram Abbreviations: FY, fiscal year; HISA, Home Improvements and Structural Alterations program; VHA, Veterans Health Administration.
See this image and copyright information in PMC

References

    1. Semeah LM, Ahrentzen S, Jia H, Cowper-Ripley DC, Levy CE, Mann WC. The home improvements and structural alterations benefits program: veterans with disabilities and home accessibility. J Disability Policy Studies. 2017;28(1):43–51. doi: 10.1177/1044207317696275. - DOI
    1. Semeah LM, Wang X, Cowper Ripley DC, Lee MJ, Ahonle ZJ, Ganesh SP, et al. Improving health through a home modification service for veterans. In: Fiedler BA, editor. Three Facets of Public Health and Paths to Improvements. Academic Press; 2020. pp. 381–416.
    1. Semeah LM, Ahrentzen S, Cowper-Ripley DC, Santos-Roman LM, Beamish JO, Farley K. Rental housing needs and barriers from the perspective of veterans with disabilities. Housing Policy Debate. 2019;29(4):542–558. doi: 10.1080/10511482.2018.1543203. - DOI
    1. Semeah LM, Ganesh SP, Wang X, et al. Home modification and health services utilization by rural and urban veterans with disabilities. Housing Policy Debate. 2021;31(6):862–874. doi: 10.1080/10511482.2020.1858923. - DOI
    1. University of Wisconsin, Population Health Institute. County health rankings model. [Accessed May 13, 2022]. https://www.countyhealthrankings.org/about-us .

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