Patient-, treatment-, and facility-level structural characteristics associated with the receipt of preoperative lower extremity amputation rehabilitation.
Patient-, treatment-, and facility-level structural characteristics associated with the receipt of preoperative lower extremity amputation rehabilitation.
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DOI：
10.1016/j.pmrj.2012.06.009
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发表时间：
2013-01
期刊：
影响因子：
2.1
通讯作者：
Xie, Dawei
中科院分区：
文献类型：
--
作者：
Bates, Barbara E.;Hallenbeck, Richard;Ferrario, Toni;Kwong, Pui L.;Kurichi, Jibby E.;Stineman, Margaret G.;Xie, Dawei
确定影响在退伍军人事务部（VA）医疗保健系统内经胫骨或经股截肢术前启动康复评估的决策的患者、治疗或机构特征。回顾性数据库研究。VA医疗中心2002年10月1日至2004年9月30日期间，共有4226名下肢截肢的退伍军人从退伍军人管理局医疗中心出院。在首次手术住院后但在手术日期前进行术前康复评估的证据。有证据表明，4226例下肢截肢的退伍军人中有343例（8.12%）接受了术前康复评估。接受术前康复的退伍军人更可能是老年人，从家里入院，或从另一家医院转移。与中型医院或东北部、东南部或中西部地区的患者相比，在小型医院或中南部或太平洋山区接受手术截肢的患者更有可能接受术前康复。有瘫痪证据的患者、在康复机构认证委员会认证的机构中接受治疗的患者（P <0.01）以及第二数据波中的患者接受术前康复的可能性较小。在考虑了患者、治疗和设施水平的结构特征后，我们发现老年患者更有可能接受术前康复服务（比值比[OR] 1.01，95%置信区间[CI] 1.01-1.02）。与无此病因的患者相比，既往截肢并发症导致截肢病因的患者更有可能接受术前咨询康复服务（OR 1.50，95% CI 1.02-2.19）。与在美国东南部地区治疗的患者相比，在中南部地区（OR 2.52，95%CI 1.82-3.48）或太平洋山区（OR 1.62，95%CI 1.11-2.37）治疗的患者更有可能接受术前咨询康复服务。有瘫痪证据的患者与没有这种情况的患者相比，接受术前康复服务的可能性更小（OR 0.29，95%CI 0.09-0.93），在中型医院治疗的患者与在小型医院治疗的患者相比，接受术前康复服务的可能性也较低（OR 0.38，95% CI 0.27-0.53）。与第一年的患者相比，第二个数据年的退伍军人接受服务的可能性较低（OR 0.74，95%CI 0.58-0.94）。下肢截肢手术前的康复评估在VA医疗保健系统中是罕见的。实践模式似乎是由位置驱动的，而不是由患者特征驱动的。
To determine patient, treatment, or facility characteristics that influence decisions to initiate a rehabilitation assessment before transtibial or transfemoral amputation within the Veterans Affairs (VA) health care system. Retrospective database study. VA medical centers. A total of 4226 veterans with lower extremity amputations discharged from a VA medical center between October 1, 2002, and September 30, 2004. Evidence of a preoperative rehabilitation assessment after the index surgical stay admission but before the surgical date. Evidence was found that 343 of 4226 veterans (8.12%) with lower extremity amputations received preoperative rehabilitation assessments. Veterans receiving preoperative rehabilitation were more likely to be older, admitted from home, or transferred from another hospital. Patients who underwent surgical amputation at smaller-sized hospitals or in the South Central or Mountain Pacific regions were more likely to receive preoperative rehabilitation compared with patients in mid-sized hospitals or in the Northeast, Southeast, or Midwest regions. Patients with evidence of paralysis, patients treated in facilities with programs accredited by the Commission on Accreditation of Rehabilitation Facilities (P < .01), and patients in the second data wave were less likely to receive preoperative rehabilitation. After accounting for patient-, treatment-, and facility-level structural characteristics, we found that older patients were more likely to receive preoperative rehabilitation services (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.01–1.02). Patients with a contributing amputation etiology of a previous amputation complication were more likely to receive preoperative consultation rehabilitation services (OR 1.50, 95% CI 1.02–2.19) compared with patients who did not have this etiology. Compared with patients treated in the Southeast region of the United States, those treated in the South Central region (OR 2.52, 95% CI 1.82–3.48) or Mountain Pacific region (OR 1.62, 95% CI 1.11–2.37) were more likely to receive preoperative consultation rehabilitation services. Patients with evidence of paralysis were less likely to receive preoperative rehabilitative services compared with patients who did not have this condition (OR 0.29, 95% CI 0.09–0.93), and patients treated in mid-sized hospitals also were less likely to receive preoperative rehabilitative services compared with patients treated in smaller-sized facilities (OR 0.38, 95% CI 0.27–0.53). Veterans in the second data year were less likely to receive services compared with patients in the first year (OR 0.74, 95% CI 0.58–0.94). Rehabilitation assessment before lower extremity amputation surgery is a rare occurrence in the VA health care system. Practice patterns appear to be driven by location and not by patient characteristics.
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DOI：
10.1016/j.apmr.2007.11.005
发表时间：
2008-03-01
影响因子：
4.3
作者：
Ziegler-Graham, Kathryn;MacKenzie, Ellen J.;Brookmeyer, Ron
通讯作者：
Brookmeyer, Ron
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
DOI：
10.1682/jrrd.2006.03.0030
发表时间：
2006-11-01
影响因子：
--
作者：
Bates, Barbara;Stineman, Margaret G.;Kwong, Pui L.
通讯作者：
Kwong, Pui L.
影响因子：
3.5
作者：
Kurichi, Jibby E.;Stineman, Margaret G.;Reker, Dean M.
通讯作者：
Reker, Dean M.
DOI：
10.1111/j.1532-5415.2007.01187.x
发表时间：
2007-06-01
影响因子：
6.3
作者：
Kurichi, Jibby E.;Kwong, Pui L.;Stineman, Margaret G.
通讯作者：
Stineman, Margaret G.