{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:06:13Z","timestamp":1789085173741,"version":"build-2803163510"},"reference-count":58,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100005191","name":"Craig Neilsen Foundation","doi-asserted-by":"crossref","award":["# 721097"],"award-info":[{"award-number":["# 721097"]}],"id":[{"id":"10.13039\/100005191","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000005","name":"Department of Defense","doi-asserted-by":"crossref","award":["W81XWH-21-1-0751"],"award-info":[{"award-number":["W81XWH-21-1-0751"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health&amp;#65533;Serv&amp;#65533;Insights"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Individuals with traumatic spinal cord injuries (TSCI) can encounter different experiences when accessing care, especially between individuals receiving care from the Veterans Affair (VA) health care insurance and commercial insurance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The purpose of this study was to explore the barriers and facilitators in access to care among individuals with TSCI receiving care from the VA and commercial insurance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>\n                      We used a qualitative descriptive study and interviewed 31 participants (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 13, receiving care through the VA;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 18, commercially insured).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants and their caregivers participated in a semi-structured interview. To analyze the data, we used thematic text analysis to identify overarching themes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified four themes: (a) challenges identifying appropriate and adequate specialized care, (b) financial assistance is limited when accessing care, (c) lack of proximity to care leads to social and contextual barriers, and (d) enhancing care through close social support systems. The first three themes were barriers to care while the latter theme was identified as a facilitator. Most participants from the VA noted challenges finding an adequate formal caregiver, whereas individuals receiving care from commercial insurance reported primarily receiving help from informal caregivers. Financial impediments were discussed between both groups, but those receiving care through commercial insurance noted the most challenges. Finally, individuals receiving care from the VA had support from the VA regarding adaptations to their home environment, whereas civilians often asked informal caregivers (e.g., family, friends, community) for help.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The findings from this study illuminate the need for specialized care centers, caregivers, and additional supports for individuals with TSCI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11786329261486136","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:21:40Z","timestamp":1788891700000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and Facilitators in Access to Care Among Adults With Traumatic Spinal Cord Injuries: A Qualitative Study Comparing VA and Commercial Insurance"],"prefix":"10.1177","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2065-7398","authenticated-orcid":false,"given":"Analay","family":"Perez","sequence":"first","affiliation":[{"name":"University of Michigan,"},{"name":"Michigan Medicine, University of Michigan,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler G.","family":"James","sequence":"additional","affiliation":[{"name":"University of Michigan,"},{"name":"Michigan Medicine, University of Michigan,"},{"name":"University of Michigan,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elham","family":"Mahmoudi","sequence":"additional","affiliation":[{"name":"University of Michigan,"},{"name":"Michigan Medicine, University of Michigan,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2021.05.014"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41393-021-00731-4"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2015.10.090"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-0191"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/cells9061420"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41393-024-01009-1"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2020.12.019"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2018.08.179"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awt262"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0028-3908(00)00005-8"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2014.21"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2014.11.024"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-021-01111-5"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2016.03.019"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2004.07.348"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40359-025-03762-1"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2021.12.004"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000006244"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41393-017-0009-3"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2024.02.363"},{"key":"e_1_3_7_22_2","unstructured":"Administration UD of VA Veterans Health. VA.gov | Veterans Affairs. https:\/\/www.publichealth.va.gov\/epidemiology\/reports\/oefoifond\/health-care-utilization\/. Accessed January 26 2026."},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmr.2021.01.007"},{"key":"e_1_3_7_24_2","unstructured":"VA.gov | Veterans Affairs. https:\/\/www.sci.va.gov\/Veterans\/HubAndSpokes.asp. Accessed May 7 2025."},{"key":"e_1_3_7_25_2","unstructured":"What\u2019s Happening Inside the Largest Spinal Cord Injury Care Delivery System in the U.S.? July 1 2024. https:\/\/www.afge.org\/article\/whats-happening-inside-the-largest-spinal-cord-injury-care-delivery-system-in-the-us\/. Accessed January 7 2026."},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2021.1890680"},{"key":"e_1_3_7_27_2","doi-asserted-by":"publisher","DOI":"10.1310\/sci17-00046"},{"key":"e_1_3_7_28_2","doi-asserted-by":"publisher","DOI":"10.20517\/2347-8659.2019.15"},{"key":"e_1_3_7_29_2","unstructured":"Overview Of Health Insurance For Spinal Cord Injury. https:\/\/www.christopherreeve.org\/todays-care\/living-with-paralysis\/costs-and-insurance\/insurance-and-medicare\/. Accessed July 24 2026."},{"key":"e_1_3_7_30_2","doi-asserted-by":"publisher","DOI":"10.1080\/01952307.1993.11735888"},{"key":"e_1_3_7_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocpiqo.2022.04.004"},{"key":"e_1_3_7_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2024.102663"},{"key":"e_1_3_7_33_2","doi-asserted-by":"publisher","DOI":"10.1177\/1744987119880234"},{"key":"e_1_3_7_34_2","doi-asserted-by":"publisher","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G"},{"key":"e_1_3_7_35_2","doi-asserted-by":"publisher","DOI":"10.1002\/nur.20362"},{"key":"e_1_3_7_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2025.02.012"},{"key":"e_1_3_7_37_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-023-04492-y"},{"key":"e_1_3_7_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2011.01.025"},{"key":"e_1_3_7_39_2","volume-title":"NINDS User Manual Quality of Life in Neurological Disorders (Neuro-QoL) Measures","author":"National Institute of Neurological Disorders and Stroke","year":"2015","unstructured":"National Institute of Neurological Disorders and Stroke . NINDS User Manual Quality of Life in Neurological Disorders (Neuro-QoL) Measures; 2015."},{"issue":"6","key":"e_1_3_7_40_2","first-page":"519","article-title":"Quantifying handicap: a new measure of long-term rehabilitation outcomes","volume":"73","author":"Whiteneck GG","year":"1992","unstructured":"Whiteneck GG, Charlifue SW, Gerhart KA, Overholser JD, Richardson GN. Quantifying handicap: a new measure of long-term rehabilitation outcomes. Arch Phys Med Rehabil. 1992;73(6):519-526.","journal-title":"Arch Phys Med Rehabil"},{"key":"e_1_3_7_41_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049732316665344"},{"key":"e_1_3_7_42_2","unstructured":"VERBI Software. MAXQDA. 2022. [computer software]. maxqda.com. Published online 2021."},{"key":"e_1_3_7_43_2","doi-asserted-by":"publisher","DOI":"10.2307\/2137284"},{"key":"e_1_3_7_44_2","volume-title":"Qualitative Inquiry & Research Design","author":"Creswell JW","year":"2018","unstructured":"Creswell JW, Poth CN. Qualitative Inquiry & Research Design. 4h edition. Sage; 2018.","edition":"4"},{"key":"e_1_3_7_45_2","doi-asserted-by":"publisher","DOI":"10.4135\/9781446288719"},{"key":"e_1_3_7_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.metip.2023.100116"},{"key":"e_1_3_7_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(03)00268-5"},{"key":"e_1_3_7_48_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1377513"},{"key":"e_1_3_7_49_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12062-015-9116-0"},{"key":"e_1_3_7_50_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbw047"},{"key":"e_1_3_7_51_2","doi-asserted-by":"publisher","DOI":"10.1080\/08959420.2017.1280748"},{"key":"e_1_3_7_52_2","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14019"},{"key":"e_1_3_7_53_2","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0000000000000620"},{"key":"e_1_3_7_54_2","doi-asserted-by":"publisher","DOI":"10.2196\/29575"},{"key":"e_1_3_7_55_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11420-020-09800-5"},{"key":"e_1_3_7_56_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2018.0613"},{"key":"e_1_3_7_57_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-018-3346-9"},{"key":"e_1_3_7_58_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049732318807208"},{"key":"e_1_3_7_59_2","doi-asserted-by":"publisher","DOI":"10.22454\/FamMed.2024.592756"}],"container-title":["Health Services Insights"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11786329261486136","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/11786329261486136","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/11786329261486136","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T23:16:39Z","timestamp":1789082199000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/11786329261486136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":58,"alternative-id":["10.1177\/11786329261486136"],"URL":"https:\/\/doi.org\/10.1177\/11786329261486136","relation":{},"ISSN":["1178-6329","1178-6329"],"issn-type":[{"value":"1178-6329","type":"print"},{"value":"1178-6329","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"article-number":"11786329261486136"}}