Overview

Large datasets and registries are essential elements for the consideration of accountable and value-based healthcare and associated policy. The field of CRT is relatively new to using large datasets and registries, and therefore policies surrounding CRT have not necessarily been based on research with standardized outcome measures, uniform datasets, or other similar strategies.

The study involves analysis of several large datasets that will be made available through data use agreements. The datasets contain information about people (e.g. basic demographics and health outcomes) and devices they use (e.g. wheelchairs). We will be conducting descriptive analyses of the data to better understand the characteristics of the devices being used to answer questions such as, “how long do devices last before they need to be repaired,” “how much do repairs cost?”, and “do people using certain kinds of devices have health outcomes like pressure ulcers?”  The overall goal of the study is to use the information obtained to draft a new policy for insurance coverage of devices including wheelchairs.

The outcome of this project will be a large Uniform Dataset merged from multiple independent sources that includes variables of interest that can be used to inform a new value-based policy model for CRT. Specifically, knowing the average reasonable useful life (RUL) and overall cost of operating various types of CRT devices can assist in informing a payment strategy. For example, knowing mileage over time with associated service messages will be the first of its kind type analysis in the CRT industry to further inform expected RUL and maintenance routines. The comprehensive data set can also be leveraged beyond the purpose of this proposal for further investigations. Stakeholder groups and researchers may be interested to know how different variables are correlated to model predictive outcomes associated across types of devices, users, and their situation which can further promote levels of research evidence in the field of CRT.

Update

As of June 1, 2023

Regular meetings are scheduled with our collaborating stakeholders along with a weekly ‘Fun with Data’ meeting with our internal data team to explore and review data analyses and questions/topics. The current 5 datasets include:

Dataset 1: Functional Mobility Assessment and Uniform Dataset Registry (FMA/UDS) – The FMA/UDS is a person-reported outcomes registry related to satisfaction in performing Mobility Related Activities of Daily Living (MRADLs) and other factors of interest including health, function, and participation that are related to various types of Complex Rehabilitation Technology (CRT). The FMA/UDS is managed through a sponsored research agreement between the University of Pittsburgh and the Van G. Miller Group’s US Rehab subsidiary (VGM/US Rehab).

Dataset 2: Labor Tracker Wheelchair Repair Registry (WRR) – Within the existing RERC Project on Wheelchair Standards, Pitt investigators have developed a Wheelchair Repair Registry (WRR) to obtain a large dataset in order to better understand the type and frequency of failures across types of devices for research and development purposes. This project is also a collaboration between Pitt and VGM/US Rehab, who maintains Labor Tracker, which is a strategy for its members to document, track and manage wheelchair repairs that also includes procedures for insurance claims.

Dataset 3: Business Operations Data from National Seating and Mobility (NSM) – NSM is one of the largest suppliers of CRT, with over 240 branches nationwide. Due to the size and scope of the company, they maintain their own business operations data infrastructure. They maintain electronic records on all CRT cases, which includes information about the device and history of repairs.

Dataset 4: Permobil Connected Wheelchair (PCW) – Permobil is a global manufacturer of high-end powered wheelchairs. There is a feature called Permobil Connect that is able to collect and transmit information about the use and performance of the device, including battery health, frequency of battery charges, hours of use, distance traveled, utilization of power functions such as seat elevation and service messages (including device errors). Permobil is working with Pitt investigators on a subset of the data to be aggregated, de-identified, and shared.

Dataset 5: UPMC Health Plan Claims Dataset (UPMC-HP) – The University of Pittsburgh Medical Center Health Plan (UPMC-HP) is a Managed Care Organization (MCO) within, but independent of, the UPMC Health System, which is an Accountable Care Organization (ACO) serving over 3.7 million lives throughout Pennsylvania and neighboring states. The HP offers several health insurance products including commercial plans as well as Medicare and Medicaid managed care plans. The Health Plan routinely collaborates with investigators to share and analyze claims data to investigate utilization and the effectiveness of various treatments and services.

Ongoing projects include the following:

CRT Device Variables: Distribution frequencies of manufacturer, model, HCPCS codes, device age, and accessories will be compared across datasets containing that information (i.e. WRR, UPMC Claims data, NSM operations data).

Team members evaluated the relationship between use of Seat Elevating Devices (SEDs) on power wheelchair user satisfaction in performing common activities of daily living as measured by the Functional Mobility Assessment (FMA) and associated Uniform Data Set within an existing wheelchair outcomes registry. The sample consisted of 1,733 power wheelchair users and compared cases who had a seat elevator (n=265) versus those who did not have one (n=1468). Results showed those with SEDs had statistically significant higher total FMA scores, higher reach and transfer scores, had higher rates of reported employment, and fewer reported falls than those without SEDs. These findings were likely due to SEDs promoting safer transfers by allowing a person to align surfaces so that they are level thus reducing falls during transfers. Additionally, SEDs allow people to more effectively reach and carry-out tasks at different surface heights. SEDs further facilitate face to face communication and visibility. This study is the first to use large datasets to provide stronger research evidence to the benefits of SEDs to improve overall functional mobility, transfer, reach, facilitate employment, and reduce falls. A similar methodology is being conducted on the use of Power Standing.

Both of these papers are in response to the Centers for Medicare & Medicaid Services National Coverage Analysis for Seat Elevation Systems as an Accessory to Power Wheelchairs (Group 3)

Repair Variables: Distribution frequency of type and incidence will be compared across datasets containing that information (i.e. WRR, UPMC-HP Claims data, and NSM operations data)

• Team members have determined the most common manual and power wheelchair service requests along with the frequency of when they need to be repaired. For example, the top five manual wheelchair components include: wheels/tires/forks; armrests; legrests/footplates; general services; and backs. While the top five power wheelchair components include: batteries & cables; electronics & related; wheels/tires; general services; and armrests. This has been further broken down by HCPCS codes for customized manual wheelchairs, tilt-in-space manual wheelchairs, and group 2 & 3 power wheelchairs accessing the above datasets. 

Health Factors: Distribution frequency of falls, pressure sores, and hospital readmissions will be compared across datasets containing that information (FMA/UDS and UPMC Claims Data).

• A retrospective cohort analysis from the Functional Mobility Assessment and Uniform Dataset Registry has been undertaken and specific objectives were to: 1) describe the demographic information of patients who were prescribed assistive mobility devices and 2) compare patients who report falling versus those who do not report a fall. Analyses are still underway, and a manuscript submission is expected next year. A similar methodology will be used when looking at other variables such as pressure sores.

A second question investigated from Aim 3 includes: How long do wheelchairs last before they have to be replaced? and how much does each type of wheelchair cost (initially plus maintenance and repairs) over its lifetime?

• This past reporting period team members categorized CRT device types by the Centers for Medicare & Medicaid Services coding scheme (i.e. HCPCS Codes). The average reasonable useful life (RUL) was calculated for different CRT device type by looking at date of acquisition to date of replacement. Acquisition costs of the device type and common accessories were determined by the DMEPOS Fee Schedule per HCPCS code as well as all the repair costs encountered over the RUL of different types of devices. The data sets involved in this analysis included the WRR, UPMCHP claims data, and NSM operations data.
• Team members reviewed detailed product descriptions of specific device types to determine common accessories prescribed. Once completed, it was determined from the above data sets what then common repairs/maintenance was needed along with how often this happened across the RUL. Team members developed an initial model specific to Group 3 power wheelchairs. This specific analysis will help guide project R4 – Development and Feasibility of a New CRT Policy Model Within an Accountable and Value-Based Care Framework. A similar methodology is being performed on other CRT device types such as K0005 manual wheelchair, tilt-in-space manual wheelchair, group 2 power wheelchair and group 4 power wheelchair.
• The initial model and cost estimates have been presented to a few manufacturers, suppliers, and payors with favorable and positive remarks. Further discussion will be held in the coming months.

A third topic investigated from Aim 4 includes: what was the mean daily distance that individuals travelled in their power wheelchairs in 2022, is this distance different between regions, and is this distance different between power wheelchair models. All of these questions are being analyzed in collaboration with Permobil and the Permobil Connected Wheelchair Data.

• Stay tuned, more to come on this analysis and future manuscripts

Dissemination Activities

Published Manuscripts

Schein, R. M., Yang, A., McKernan, G. P., Mesoros, M., Pramana, G., Schmeler, M. R., & Dicianno, B. E. (2021). Effect of the Assistive Technology Professional on the Provision of Mobility Assistive Equipment. Archives of physical medicine and rehabilitation, 102(10), 1895–1901. https://doi.org/10.1016/j .apmr.2021.03.024

Cuppett, M., Schein, R. M., Pramana, G., Dicianno, B. E., & Schmeler, M. R. (2022). Investigation of factors from assistive technology professionals that impact timeliness of wheelchair service delivery: a cross-sectional study. Disability and rehabilitation. Assistive technology, 1–5. Advance online publication. https://doi.org/10.1080/1 7483107.2022.2048099

Ruffing, J.J., Schmeler, M.R., Schein, R.M., & Mhatre, A. (2022). A cross-sectional descriptive analysis of complex rehabilitation technology (CRT) supplier opinions on the current state of wheelchair repair services. Disability and rehabilitation. Assistive technology, 1–6. Advance online publication. https://doi.org/10.1080/17483107.2022.2121007

Mesoros, M.J., Schein, R.M., Pramana, G., Schiappa, V.J., Schmeler, M.R., & Dicianno, B.E. (2022). Functional mobility, employment and safety benefits of seat elevating devices. Assistive technology : the official journal of RESNA, 1–6. Advance online publication. https://doi.org/10.1080/10400435.2022.2124469

Nieto, A., Pramana, G., Schein, R. M., & Schmeler, M. R. (2023). Estimating power wheelchair battery lifespan based on real-world data. Disability and rehabilitation. Assistive technology, 18(2), 140–144. https://doi.org/10.1080/17483107.2022.2133182 

• a publication from a previous NIDILRR-funded award with content area related to this current award, that was published during the current reporting period.

Manuscripts in Review

Implementation and Lessons Learned from the Functional Mobility Assessment and Uniform Dataset Registry

• submitted to Assistive Technology Special Issue on Outcomes; received comments for revisions

Manuscripts in Preparation

• Leveraging Big Data from the Connected Power Wheelchair: How Far People Travel
• Large Data Analysis of Falls in People with Mobility Limitations

Other Dissemination Activities

McKernan, G., Schein, R.M., Schmeler, M.R., Pramana, G. Mesoros, M. & Dicianno, B.E. (2022, February). Impact of the Assistive Technology Professional in the Provision of Mobility Assistive Equipment. International Seating Symposium (ISS). https://www.seatingsymposium.us/eventschedule/event/

Dicianno BE. Archives of PM&R podcast to a follow-up on the manuscript, ‘Effect of the Assistive Technology Professional on the Provision of Mobility Assistive Equipment’ – awaiting the publication podcast link

Mesoros MJ, Schein RM, Pramana G, Schiappa VJ, Schmeler MR, Dicianno BE. (2022). Functional Mobility, Employment and Safety Benefits of Power Adjustable Seat Height. UPMC Rehabilitation Institute Research Day.

• Download Poster

Schmeler, M.R., Dicianno, B., Schein, R.M., & Pramana, G. (2023, April 14). Datasets & Registries Related to Complex Rehabilitation Technology. International Seating Symposium (ISS).