Do Amputees Benefit from Comprehensive Rehabilitation Services

截肢者是否可受惠于综合康复服务？ .这项正在进行的工作的政策相关性至关重要。这种重新应用是对来自 美国国立卫生研究院和医疗保险和医疗补助服务中心（CMS）。 支持康复的做法。如果没有有效的证据，康复服务可能会 减少或消除，从而损害与经胫骨或 经股动脉截肢退伍军人健康管理局（VHA）和医疗保险政策的变化是 刺激从住院到门诊服务的转变，没有经验证据支持或不支持 支持这些服务。私营部门的纵向数据来源很少，如果有的话， 解决替代康复护理模式或相关长期结果的好处。结果 我们目前的项目提供的证据支持的有效性， 服务和那些提供了一个专门的康复病床单位的退伍军人，而仍然住院 经胫骨或经股骨截肢后。在我们最初的4,727名截肢者中， 在“急性术后”期间接受住院康复治疗。我们提出的续约计划的动机是 需要研究大多数（67%）截肢者接受的康复服务， 术后急性期住院康复。我们建议探索结果的变化 根据不同的时间（急性术后除外），地点， 以及接受的康复服务类型。功能恢复程度将在结束时确定 康复和出院回家的问题将只针对住院模式。一，二 和3年生存结局、长期护理安置、再次截肢、再次住院、假体 处方，和总的医疗保健费用将确定所有模式的分析。方法将包括 一系列观察性研究，估计有7,000名截肢者，并对这些截肢者进行了亚组分析。 使用倾向评分匹配和工具变量分析调整65岁及以上 选择偏差和混合模型来解释设施内的患者聚集。这些方法将 应用于确定在急性术后期间发现的康复益处是否适用于不同的 在不同的时间和地点适用的康复类型。我们将确定最有可能 接受各种康复护理模式以及相关的预期出院和3年结局。到 据我们所知，这项正在进行的对截肢老兵人群的研究是首次尝试对截肢者的形象进行描述。 为特定的患者群体提供完整的急性、康复和长期护理服务。我们 预计这项研究将大大扩大有限的经验知识的相关性， 截肢者的康复和急性期后护理。这种基于证据的知识对于指导 VHA和私营部门的未来做法和政策。

Do Amputees Benefit from Comprehensive Rehabilitation Services? . The policy relevance of this ongoing work is critical. This reapplication is in direct response to a call from the NIH and Center for Medicare and Medicaid Services (CMS).to develop NIH-level research providing evidence supporting the practices of rehabilitation. Without evidence of effectiveness, rehabilitation access will likely be curtailed or eliminated to the detriment of people with potentially reducible disabilities related to trans-tibial or trans-femoral amputation Changes in both Veterans Health Administration (VHA) and Medicare policies are stimulating shifts from inpatient to outpatient services without empirical evidence either supporting or not supporting those services. There are few, if any, sources of longitudinal data in the private sector available to address the benefits of alternative rehabilitation care patterns or associated long-term outcomes. Results from our current project provide evidence supporting the effectiveness of both generalized consultative rehabilitation services and those provided on a specialized rehabilitation bed unit for veterans while still hospitalized following trans-tibial or trans-femoral amputation. Only 33% of the 4,727 amputees in our initial sample received inpatient rehabilitation during the "acute postoperative" period. Our proposed renewal is motivated by the need to study rehabilitation services received by the majority (67%) of amputees with no evidence of inpatient rehabilitation during the acute postoperative period. We propose to explore variation in outcomes comparing different rehabilitation care patterns according to the time (other than acute postoperative), place, and type of rehabilitation services received. The degree of functional recovery will be determined at conclusion of rehabilitation, and home discharge from the hospital will be addressed for inpatient patterns only. One-, 2- and 3-year outcomes of survival, long-term care placement, re-amputation, re-hospitalization, prosthetic prescription, and total health care costs will be determined for all patterns analyzed. Methods will include a series of observational studies on an estimated cohort of 7,000 amputees with a sub-group analysis of those 65 years of age and older using propensity score matching and instrumental variable analyses to adjust for selection bias and mixed models to account for patient clustering within facilities. These methods will be applied to determine if the benefits of rehabilitation found in the acute postoperative period hold for different types of rehabilitation applied at diverse times and places. We will identify the types of patients most likely to receive various rehabilitation care patterns and the associated expected discharge and 3 year outcomes. To our knowledge, this ongoing study of the veteran amputee population represents a first attempt to image the full continuum of acute, rehabilitation, and long-term care services received by a defined group of patients. We anticipate that this research will greatly expand the limited body of empirical knowledge of relevance to the rehabilitation and post-acute care of amputees. Such evidence-based knowledge will be essential to guide future practice and policies in the VHA and private sectors alike.