Do Amputees Benefit from Comprehensive Rehabilitation Services

截肢者是否受益于综合康复服务？ 。这项正在进行的工作的政策相关性至关重要。此重新应用程序直接响应来自 NIH和医疗保险和医疗补助服务中心(CMS)。开发NIH级别的研究提供证据 支持康复实践。如果没有有效性的证据，康复途径很可能是 减少或消除对具有潜在可恢复残疾的人的损害，这些残疾与跨胫骨或 退伍军人健康管理局(VHA)和医疗保险政策中经股截肢的变化是 在没有经验证据支持或不支持的情况下，刺激从住院到门诊的转变 支持这些服务。私营部门的纵向数据来源很少，如果有的话，可以 解决替代康复护理模式的好处或相关的长期结果。结果来自 我们目前的项目提供了证据，支持普遍咨询性康复的有效性 在退伍军人住院期间在专门康复床位上提供的服务和服务 在经胫骨或经股骨截肢后。在我们最初的样本中，4727名截肢者中只有33% 在“急性术后”期间接受住院康复治疗。我们提议续签的动机是 需要研究大多数(67%)截肢者接受的康复服务，但没有证据表明 住院患者术后急性期康复。我们建议探索结果的差异。 比较不同康复护理模式的时间(急性术后除外)、地点、 以及接受的康复服务的类型。功能恢复的程度将在结论时确定 康复和家庭出院将仅针对住院患者模式。1-2- 以及生存、长期护理安置、再次截肢、再次住院、假体修复的3年结果 处方药，将确定所有分析模式的医疗保健总成本。方法将包括一个 对约7,000名截肢者进行了一系列观察性研究，并对这些人进行了分组分析 65岁及以上，使用倾向得分匹配和工具变量分析进行调整 选择偏向和混合模型，以解释设施内的患者聚集。这些方法将是 应用于确定康复在术后急性期的益处是否适用于不同的 康复类型适用于不同的时间和地点。我们将确定最有可能的患者类型 接受各种康复护理模式以及相关的预期出院和3年结果。至 据我们所知，这项正在进行的关于退伍军人截肢者群体的研究是首次尝试将 由确定的一组患者接受的急诊、康复和长期护理服务的完整连续。我们 预计这项研究将极大地扩大与 截肢者的康复和急性后护理。这种以证据为基础的知识对于指导 VHA和私营部门未来的做法和政策。

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.