Factors Associated With Utilization of Preoperative and Postoperative Rehabilitation Services by Patients With Amputation in the VA System: An Observational Study

Physical Therapy - Tập 93 Số 9 - Trang 1197-1210 - 2013
Linda Resnik1, Matthew Borgia2
1L.J. Resnik, PT, PhD, Center for Gerontology and Health Care Research, Brown University, 2 Stimson Ave, Providence, RI 02912 (USA).
2M.L. Borgia, AM, Department of Veterans Affairs–Research, Providence, Rhode Island.

Tóm tắt

Background The Department of Veterans Affairs (VA) and the Department of Defense published evidence-based guidelines to standardize and improve rehabilitation of veterans with lower limb amputations; however, no studies have examined the guidelines' impact. Objectives The purposes of this study were: (1) to describe the utilization of rehabilitative services in the acute care setting by people who underwent major lower limb amputation in the VA from 2005 to 2010, (2) to identify factors associated with receipt of rehabilitation services, and (3) to examine the impact of the guidelines on service receipt. Design A cross-sectional study of 12,599 patients, who underwent major surgical amputation of the lower limb at a VA medical center from January 1, 2005, to December 31, 2010, was conducted. Data were obtained from main and surgical inpatient datasets and the inpatient encounters files of the Veterans Health Administration databases. Methods Rehabilitation services were categorized as physical therapy, occupational therapy, and either (any therapy), before or after amputation. Separate multivariate logistic regressions examined the impact of guideline implementation and identified factors associated with service receipt. Results Patients were 1.45 and 1.73 times more likely to receive preoperative physical therapy and occupational therapy and 1.68 and 1.79 times more likely to receive postoperative physical therapy and occupational therapy after guideline implementation. Patients in the Northeast had the lowest likelihood of receiving preoperative and postoperative rehabilitation services, whereas patients in the West had the highest likelihood. Other patient characteristics associated with service receipt were identified. Limitations The sample included only veterans who had surgeries at VA Medical Centers and cannot be generalized to veterans with surgeries outside the VA or to nonveteran patients and settings. Conclusions Further quality improvement efforts are needed to standardize delivery of rehabilitation services for veterans with amputations in the acute care setting.

Từ khóa


Tài liệu tham khảo

US Department of Veterans Affairs. VA/DoD Clinical Practice Guideline for Rehabilitation of Lower Limb Amputation. Available at: http://www.healthquality.va.gov/Lower_Limb_Amputation.asp. Accessed March 30, 2011.

Esquenazi, 1966, Rehabilitation in limb deficiency, 4: limb amputation, Arch Phys Med Rehabil, 77, S18, 10.1016/S0003-9993(96)90239-7

Stineman, 2010, Prognostic differences for functional recovery after major lower limb amputation: effects of the timing and type of inpatient rehabilitation services in the Veterans Health Administration, PM R, 2, 232, 10.1016/j.pmrj.2010.01.012

Zhou, 2011, Factors influencing receipt of outpatient rehabilitation services among veterans following lower extremity amputation, Arch Phys Med Rehabil, 92, 1455, 10.1016/j.apmr.2011.03.029

Dillingham, 2005, Postacute care services use for dysvascular amputees: a population-based study of Massachusetts, Am J Phys Med Rehabil, 84, 147, 10.1097/01.PHM.0000154899.49528.05

Dillingham, 1998, Incidence, acute care length of stay, and discharge to rehabilitation of traumatic amputee patients: an epidemiologic study, Arch Phys Med Rehabil, 79, 279, 10.1016/S0003-9993(98)90007-7

Dillingham, 2003, Discharge destination after dysvascular lower-limb amputations, Arch Phys Med Rehabil, 84, 1662, 10.1053/S0003-9993(03)00291-0

Stineman, 2008, The effectiveness of inpatient rehabilitation in the acute postoperative phase of care after transtibial or transfemoral amputation: study of an integrated health care delivery system, Arch Phys Med Rehabil, 89, 1863, 10.1016/j.apmr.2008.03.013

Bates, 2009, Factors influencing decisions to admit patients to veterans affairs specialized rehabilitation units after lower-extremity amputation, Arch Phys Med Rehabil, 90, 2012, 10.1016/j.apmr.2009.07.016

Kurichi, 2009, Possible incremental benefits of specialized rehabilitation bed units among veterans after lower extremity amputation, Med Care, 47, 457, 10.1097/MLR.0b013e31818b08c6

Bates, 2007, Does the presence of a specialized rehabilitation unit in a Veterans Affairs facility impact referral for rehabilitative care after a lower-extremity amputation?, Arch Phys Med Rehabil, 88, 1249, 10.1016/j.apmr.2007.06.018

Kurichi, 2011, Factors associated with late specialized rehabilitation among veterans with lower extremity amputation who underwent immediate postoperative rehabilitation, Am J Phys Med Rehabil, 90, 387, 10.1097/PHM.0b013e31820636c4

Smith, 2010, Matching prosthetics order records in VA National Prosthetics Patient Database to healthcare utilization databases, J Rehabil Res Dev, 47, 725, 10.1682/JRRD.2009.07.0098

Freburger, 2012, Delivery of physical therapy in the acute care setting: a population-based study, Phys Ther, 92, 251, 10.2522/ptj.20100337

Center VIR . Data Quality: Race and Ethnicity Information in Medical SAS Datasets. Available at: http://www.virec.research.va.gov/DataQuality/Overview.htm. Accessed May 29, 2013.

Center, 2011, VIReC Technical Report: VA Race Data Quality

HCUP Comorbidity Software. Healthcare Cost and Utilization Project [SAS macro code]. Available at: http://www.hcup-us.ahrq.gov/toolssoftware/comorbidity/comorbidity.jsp. Accessed November 15, 2011.

Konety, 2005, Impact of hospital and surgeon volume on in-hospital mortality from radical cystectomy: data from the health care utilization project, J Urol, 173, 1695, 10.1097/01.ju.0000154638.61621.03

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Physical Therapy

Tập 93 Số 9

1197-1210

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