Dysvascular Amputees: Rehabilitation Use and Outcomes

描述（由申请人提供）：由周围血管疾病和糖尿病（血管异常原因）引起的截肢是老年人永久性损伤和功能限制的重要来源。我们通过我们的工作了解到：(1)在美国，血管异常截肢率持续上升；（ii）相当比例的血管障碍截肢者在一年内继续进行额外截肢；（iii）美国康复服务的利用率相对较低，并且具有很大的地理差异；非裔美国人截肢的风险是白人的两到四倍。尽管通过适当的康复有可能增强功能，但对于在不同的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。这种竞争性更新的目的是双重的；(1)前瞻性比较在三种不同环境（住院康复单位、专业护理机构和在家）接受康复护理的血管障碍截肢者队列的结果，以及(2)确定在这些环境中提供急性后护理的成本效益，以改善截肢后6个月的预后。主要数据将从医疗记录和截肢后最初的患者访谈中获得，并在6个月后通过电话随访在巴尔的摩一家参与研究的医院接受手术的血管障碍截肢患者样本。多变量技术将用于比较不同设置的结果，控制患者特征、初始残疾水平和其他混杂因素。将通过计量经济模型和模拟技术进行替代康复环境的成本效益分析。这些重要的结果和成本效益结果将为临床医生、消费者、保险公司和卫生政策制定者提供关于血管障碍截肢患者最适当的康复护理的信息。

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.