Dysvascular Amputees: Rehabilitation Use and Outcomes

描述（由申请人提供）：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。我们通过工作了解到：（一）美国的血管障碍截肢率继续上升;（二）相当大比例的血管障碍截肢者在一年内继续接受截肢;（三）美国对康复服务的利用率相对较低，其特点是地域差异很大;非洲裔美国人截肢的风险比白色人高2 - 4倍。尽管通过适当的康复有可能增强功能，但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。这种竞争性更新的目的是双重的;（i）前瞻性地比较在三种不同环境中接受康复护理的血管障碍截肢者队列的结局-住院康复单位，专业护理机构和家中，以及ii）确定在这些环境中提供的急性后护理的成本效益，以改善截肢后6个月的结局。主要数据将在截肢后最初从病历和患者访谈中获得，并在6个月后通过电话随访在参与研究的巴尔的摩医院接受手术的血管障碍截肢者样本。将使用多变量技术比较不同环境下的结局，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的结果将告知临床医生，消费者，保险公司和卫生政策制定者，关于最适当的康复护理的人接受血管障碍截肢。

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.