Stakeholder-driven approach to optimizing access to low vision rehabilitation services in Massachusetts
Kaldenberg, Jennifer Marie
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BACKGROUND: Visual impairment impacts over 15% of Americans over the age of 65, roughly 7.3 million people. Currently there is no statewide model for low vision rehabilitation services that serves individuals across the visual impairment continuum. This dissertation sought to examine the existing eye care service delivery models, identify best practices, and explore perceived barriers and facilitators to access low vision rehabilitation services for older adults in order to inform the development of a revised service delivery model. The model will guide practice and policy change for existing and future services. METHODS: A mixed methods convergent approach was used to achieve the study’s overarching objectives. First, quantitative data from a synthetic estimation, was used to categorize high and low resource communities, which informed the purposeful sampling of focus groups and provided essential data to guide model development. Next, focus groups and one-on-one key stakeholder interviews were held to understand stakeholder perspectives on access to low vision rehabilitation services in both high and low resource communities. Further, one-on-one interviews with focus group participants provided additional quantitative data on individual prioritized barriers. Taken together, qualitative and quantitative research was conducted concurrently and then merged and expanded to inform a low vision rehabilitation focused care delivery model grounded in the Institute for Health Improvement’s Chronic Care Model. RESULTS: Key findings indicate the need for a model of service delivery that provides the full continuum of care, beginning with a low vision eye exam, which is coordinated throughout the community and health systems and addresses the chronic nature of visual impairment. Care should be client-centered and provided when the client is ready to accept services. Lastly, ongoing education to health care providers, consumers, and society will facilitate productive interactions and positive health outcomes. CONCLUSION: The stakeholder-driven low vision rehabilitation focused care delivery model grounded in the Chronic Care Model will provide a structure for service delivery throughout the state. This collaboration with community and health systems, as well as case management, will assist with program sustainability and reach to all adults throughout the state living with VI.