Dysvascular Amputees: Rehabilitation Use and Outcomes

描述(申请人提供)：外周血管疾病和糖尿病(血管障碍原因)导致的截肢是老年人永久性损伤和功能限制的重要来源。我们从我们的工作中了解到，(I)美国血管障碍截肢率继续上升；(Ii)相当大比例的血管障碍截肢者在一年内继续接受额外的截肢；(Iii)美国康复服务的利用率相对较低，且具有巨大的地理差异；以及(Iv)非裔美国人截肢的风险是白人的两到四倍。尽管有可能通过适当的康复来增强功能，但人们对在不同护理环境中为这些截肢者提供的康复服务的有效性知之甚少。这一竞争性更新的目的有两个；(I)前瞻性地比较在三种不同环境-住院康复病房、熟练护理设施和家庭-接受康复护理的血管功能障碍截肢者的结果，以及ii)确定在这些环境中提供急性后护理在改善截肢后六个月结果方面的成本效益。主要数据将从截肢后的医疗记录和患者访谈中获得，并在6个月后通过电话对在巴尔的摩一家参与医院接受手术的血管障碍截肢者进行随访。多变量技术将被用来比较不同环境的结果，控制患者的特征、初始残疾水平和其他混杂因素。将通过计量经济学建模和模拟技术对替代康复环境进行成本效益分析。这些重要的结果和成本效益结果将使临床医生、消费者、保险公司和卫生政策制定者了解对接受血管功能障碍截肢的人进行最适当的康复护理。

DESCRIPTION (provided by applicant): Amputations resulting from peripheral vascular disease and diabetes (dysvascular causes) represent an important source of permanent impairments and functional limitations for the elderly. We have learned through our work that (i) rates of dysvascular amputations continue to rise in the United States; (ii) a substantial proportion of dysvascular amputees go on to have additional amputations within one year; (iii) utilization of rehabilitation services in the United States is relatively low and characterized by substantial geographic variation; and iv) African Americans are at two- to four-fold greater risks for amputation than white persons. Despite the potential for enhancement of function through appropriate rehabilitation, little is known about the effectiveness of rehabilitation services provided in different care settings for these amputees. The purpose of this competitive renewal is twofold; (i) to prospectively compare the outcomes for a cohort of dysvascular amputees receiving rehabilitative care in three different settings- inpatient rehabilitation units, skilled nursing facilities, and at home, and ii) to determine the cost-effectiveness of post-acute care delivered in these settings at improving outcomes at six months post amputation. Primary data will be obtained from medical records and patient interviews initially after amputation and by telephone follow up 6 months later for a sample of dysvascular amputees undergoing surgery at one of the participating Baltimore hospitals. Multivariate techniques will be utilized to compare outcomes across settings, controlling for patient characteristics, initial disability levels, and other confounders. Cost-effectiveness analyses for alternative rehabilitation settings will be conducted through econometric modeling and simulation techniques. These important outcome and cost-effectiveness results will inform clinicians, consumers, insurers, and health policy makers, regarding the most appropriate rehabilitation care for persons undergoing dysvascular amputations.