AMPREDICT PRO- Predicting Prosthetic Mobility and Matching Prosthetic Characteristics to Patient Functional Goals

AMPREDICT PRO - 预测假肢活动性并将假肢特征与患者功能目标相匹配

• 批准号: 10014657
• 负责人: Daniel C Norvell
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-10-01 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10014657
• 关键词: Activities of Daily Living; Address; Adult; Affect; Amputation; Amputees; Back; Caring; Characteristics; Clinical; Clinical Practice Guideline; Cognitive; Computerized Medical Record; Continuity of Patient Care; Data; Databases; Decision Making; Department of Defense; Development; Environment; Evaluation; Future; Gender; Geography; Goals; Health; Health Care Visit; Health Personnel; Health Services Accessibility; Health behavior; Healthcare; Healthcare Systems; Hour; Individual; Inpatients; Internet; Limb Prosthesis; Literature; Lower Extremity; Measures; Medical; Mental Health; Modeling; Nutritional; Outcome; Outcome Measure; Outpatients; Patient Care; Patient Self-Report; Patient-Focused Outcomes; Patients; Population; Probability; Procedures; Prosthesis; Provider; Publishing; Quality of life; Recommendation; Rehabilitation therapy; Reporting; Research; Resources; Risk; Risk Factors; Role; Shapes; Social support; System; Time; Travel; United States Agency for Healthcare Research and Quality; Variant; Veterans; Walking; analytical tool; base; care systems; clinical decision support; comorbidity; cost; data warehouse; demographics; design; experience; health care availability; health care disparity; health related quality of life; improved; individual patient; mobility rehabilitation; model development; patient expectation; patient subsets; predictive modeling; programs; rehabilitative care; relative effectiveness; satisfaction; smartphone Application; support tools; systematic review; tool

Recent research has highlighted the challenges faced by the clinical rehabilitation team in determining if a dysvascular amputee patient is a prosthetic candidate, formulating the most appropriate rehabilitation plan based upon their functional goals, and developing a prosthetic prescription that best matches their probable mobility outcome. The current prescription paradigm involves the estimation of the patient's future mobility outcomes using K-levels. The appropriate prosthetic componentry is then matched to the predicted K-level. This approach is wrought with challenges and clinicians do not have a lot of confidence in the system. There is no evidence to back the clinician's ability to use K-levels to predict future function. Current clinical practice guidelines also do not offer adequate evidence or guidance to shape these decisions. The time of initial prosthetic evaluation is a key time point in the amputee care continuum that can profoundly influence later outcome. Lower extremity amputations are a major health care concern within the VA Health Care System. The VA Amputee System of Care (ASoC), which is a specialized clinical program within Rehabilitation Care Services, has been implemented with the primary goal of enhancing amputee care and improving patient outcomes. This program is concerned with the most appropriate management of amputees to maximizing function and quality of life, as well as reducing health care disparities between regions and improving geographical access to health care resources. To improve the establishment of rehabilitation mobility goals, the provision of the optimum prosthetic device to meet those goals, we must address one of the key perceived needs of amputee rehabilitation providers. We propose to develop a prediction model (AMPREDICT- PROsthetics) that will predict mobility outcome based upon key predictors including demographic, comorbidity, health behavior, cognitive, mental health, access to care, reamputation, stump factors, rehab environment, and prosthetic component sophistication available at the time of prosthetic prescription. It will enhance prosthetic prescription and assist the rehabilitation team in setting realistic goals, as well as manage patient expectations. Ultimately, it should reduce regional variation in care and enhance decision making to all VHA facilities that perform this procedure. Although not a primary aim of the proposed research, the successful development of the proposed prediction model may have additional downstream benefits for this population, reducing trial and error, prosthetic component fitting, with its incumbent dollar costs and patient costs in terms of travel and repeated health care visits. If successful, it could be implemented into VA/DoD Clinical Practice Guidelines and implemented throughout the VA Amputation System of Care.

最近的研究强调了临床康复团队在确定是否a是否存在的挑战 血管血管截肢者患者是假肢候选者，制定了最合适的康复计划 基于他们的功能目标，并开发一种假肢处方，该处方最能匹配其可能 流动性结果。当前的处方范式涉及对患者未来移动性的估计 使用K级的结果。然后将适当的假体组件与预测的K级匹配。 这种方法是面临挑战，临床医生对系统没有太大的信心。有 没有证据支持临床医生使用K级预测未来功能的能力。当前的临床实践 指南也没有提供足够的证据或指导来制定这些决定。初始时间 假体评估是截肢者护理连续体的关键时间点，以后会深刻影响 结果。下肢截肢是VA医疗保健系统中的主要医疗保健问题。 VA截肢者护理系统（ASOC），这是康复护理中的专门临床计划 服务已实施，其主要目标是增强截肢者护理和改善患者 结果。该计划涉及最合适的截肢者的管理，以最大程度地提高 生活和生活质量，以及减少地区之间的医疗保健差异并改善 地理访问医疗保健资源。为了改善康复活动目标的建立， 提供最佳的假肢以实现这些目标，我们必须解决关键的感知之一 截肢者康复提供者的需求。我们建议开发一个预测模型（Ampredict- 假肢）将根据包括人口统计，合并症，合并症的关键预测因子来预测流动性结果 健康行为，认知，心理健康，获得护理，转向，树桩因素，康复环境和 假体处方时可用的假体成分。它将增强假肢 处方并协助康复团队设定现实目标，并管理患者的期望。 最终，它应减少护理的区域差异，并增强对所有VHA设施的决策 执行此过程。尽管不是拟议研究的主要目的，但成功发展 拟议的预测模型可能会为该人群具有额外的下游福利，减少试验和 错误，假肢组件拟合，其现有美元成本和患者成本在旅行和 反复的医疗访问。如果成功，可以将其实施到VA/DOD临床实践指南中 在整个VA截肢系统中实施。