Understanding prosthetic needs and outcomes in women Veterans with amputation

背景：VA在开发和提供最先进的假肢技术方面有着悠久的历史， 下肢截肢退伍军人康复服务（莱亚）。尽管VA的目标是提供 以患者为中心，对所有退伍军人的性别敏感的护理，VA的假肢研究主要包括， 专注于男人的需求。女性是VA增长最快的人口，VA目前提供 为1,200多名患有重大莱亚的妇女提供护理。随着女性人数的增加， 退伍军人人数目前处于历史最高点，预计将继续上升。康复的主要目标 在主要莱亚之后，包括成功地装配假体和提供使用假体的培训， 实现功能性移动。更多的假体使用与改善活动性、功能和 独立性和更好的生活质量。因此，确定妇女在多大程度上实现功能 通过适合他们并满足他们需求的假体实现活动性对于确保VA提供良好的 公平的照顾。因此，本研究的目的是提供信息，将改善临床护理 有莱亚的女性退伍军人 目的：本研究的目的是：1）表征假体处方率，假体-器械 严重莱亚女性患者的类型、处方时间及其相关性，并评估性别 使用行政数据分析这些结果的差异; 2）确定实现目标的障碍和促进因素 成功的功能活动，影响假体使用和满意度的因素，以及需求和偏好 与使用定性方法规定假体的严重莱亚女性中的假体相关 访谈;和3）表征假体使用，假体满意度，功能移动性，和健康相关的 女性的生活质量及其相关因素，并评估这些结果的性别差异 使用调查数据。 方法：为了实现这些目标，我们将利用VA广泛的电子病历数据， 包括企业数据仓库和国家假肢患者数据库（Aim 1），以及 对患有莱亚的退伍军人进行定性访谈（目标2）和定量调查（目标3）。两 行政数据和调查将包括妇女和男子，以全面描述妇女的特点， 与男人相比。关于最终假体处方的信息将来自行政数据， 将企业数据仓库中识别的个人与国家假肢患者数据库中的数据联系起来 数据库;将通过调查评估其他结局。对于目标2，我们将进行半结构化电话 采访了一个样本的妇女与一个主要的莱亚谁被规定的假肢。目标3将涉及 自我管理的邮寄调查，这将使我们能够描述假体使用，假体满意度， 功能移动性和健康相关的生活质量，并评估临床，社会/环境， 假体医生/假体相关因素作为妇女结局的潜在决定因素， 解释观察到的性别差异的潜在媒介。 影响：VA实现其愿景，成为提供终身，性别敏感截肢的世界领导者 护理，评估妇女的假体和功能结果是至关重要的，因为了解这些因素 这可能会对女性的假肢和功能产生消极和积极的影响。这项研究将 显著扩大女性退伍军人与莱亚的证据基础，并产生信息， 为这一人群的临床护理提供信息。

Background: The VA has a long history of developing and providing state-of-the-art prosthetic technology and rehabilitation services for Veterans with lower extremity amputations (LEA). Despite VA’s goal to provide patient-centered, gender-sensitive care to all Veterans, prosthetics research in VA has mainly included and focused on the needs of men. Women are the fastest growing demographic in VA, and VA currently provides care to over 1,200 women with a major LEA. That number will likely increase as the number of women Veterans, currently at its highest point in history, is expected to continue rising. Primary goals of rehabilitation following a major LEA include successfully fitting a prosthesis and providing training to use the prosthesis to achieve functional mobility. Greater prosthesis use is associated with improved mobility, functioning, and independence as well as better quality of life. Thus, identifying the extent to which women achieve functional mobility through prostheses that fit them and meet their needs is critical to ensure that VA is providing excellent and equitable care. Accordingly, the goal of this research is to provide information that will improve clinical care for women Veterans with LEA. Objectives: The objectives of this study are to: 1) characterize prosthetic prescription rates, prosthetic-device types, time to prescription, and their correlates among women with major LEA as well as evaluate gender differences in these outcomes using administrative data; 2) identify barriers and facilitators to achieving successful functional mobility, factors impacting prosthetic use and satisfaction, and needs and preferences related to prostheses among women with major LEA who were prescribed a prosthesis using qualitative interviews; and 3) characterize prosthetic use, prosthetic satisfaction, functional mobility, and health-related quality of life and their correlates among women as well as evaluate gender differences in these outcomes using survey data. Methods: To achieve these objectives, we will capitalize on VA’s extensive electronic medical record data, including the Corporate Data Warehouse and National Prosthetics Patient Database (Aim 1), as well as conduct qualitative interviews (Aim 2) and a quantitative survey (Aim 3) with Veterans with LEA. Both administrative data and the survey will include women and men, to characterize women overall and in comparison to men. Information on prescriptions for definitive prostheses will come from administrative data by linking individuals identified in the Corporate Data Warehouse with data in the National Prosthetics Patient Database; other outcomes will be assessed via survey. For Aim 2, we will conduct semi-structured telephone interviews with a sample of women with a major LEA who were prescribed a prosthesis. Aim 3 will involve a self-administered mailed survey that will permit us to characterize prosthetic use, prosthetic satisfaction, functional mobility, and health-related quality of life and evaluate clinical, social/environmental, and prosthetist/prostheses-related factors as potential determinants of outcomes among women as well as potential mediators that explain observed gender differences. Impact: For VA to realize its vision of being a world leader in providing lifelong, gender-sensitive amputation care, assessing prosthetic and functional outcomes among women is critical, as is understanding the factors that may negatively and positively contribute to women’s prosthetic and functional outcomes. This study would significantly expand the evidence base for women Veterans with LEA and produce information that would inform improvements in clinical care for this population.