Empirical evidence supporting patient admission to comprehensive rehabilitation bed units (RBU) as opposed to usual care post-surgical amputation is lacking. There are currently no sources of data in the private sector available to address the marginal benefits of RBU services when compared to less comprehensive levels of rehabilitation. This non-randomized study comparing patients undergoing rehabilitation across settings takes advantage of a series of linkable patient information systems spanning acute and post acute care (PAC) services available to the Veterans Health Administration (VHA) to establish outcome and resource use benchmarks, and to determine if more comprehensive interdisciplinary rehabilitation treatment following trans-tibial or trans-femoral amputation is associated with better outcomes. Outcomes will include the achievement of mobility and self-care independence; discharge to the community; provision of a prosthetic limb within one year of surgery; in-hospital 3, 6, and 12-month any cause mortality; and total acute and PAC treatment costs. Through a pseudo-experimental design using multi-variable risk factor analyses and propensity score matching to adjust for patient matching and heterogeneity, we will determine if there are incremental benefits relative to RBU admission or formal rehabilitation consultation compared to usual care. Multiple sources of data will be merged on all first-time amputees discharged 2002, 2003, 2004, and 2005 from VHA Medical Centers across the nation (anticipated N >6,000 amputees). If successful, the project will yield tools for identifying the patients most likely to benefit from high cost comprehensive RBU services and generate case-mix-adjusted quality indicators that can span PAC rehabilitation within the VHA. Additionally it will establish evidence-based instruments for prognostication, allowing clinicians to judge amputees' progress over time and it will provide evidence (or the lack thereof) for the marginal benefits of various levels of rehabilitation. This project can serve as a demonstration to the assessment of the continuum of private sector PAC rehabilitation services.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD042588-02
Application #
6795394
Study Section
Social Sciences, Nursing, Epidemiology and Methods 4 (SNEM)
Program Officer
Quatrano, Louis A
Project Start
2003-09-01
Project End
2007-05-31
Budget Start
2004-06-01
Budget End
2005-05-31
Support Year
2
Fiscal Year
2004
Total Cost
$350,921
Indirect Cost
Name
University of Pennsylvania
Department
Physical Medicine & Rehab
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Kurichi, Jibby E; Kwong, Pui; Vogel, W Bruce et al. (2015) Effects of prosthetic limb prescription on 3-year mortality among Veterans with lower-limb amputation. J Rehabil Res Dev 52:385-96
Varma, Priya; Stineman, Margaret G; Dillingham, Timothy R (2014) Epidemiology of limb loss. Phys Med Rehabil Clin N Am 25:1-8
Kurichi, Jibby E; Ripley, Diane Cowper; Xie, Dawei et al. (2013) Factors associated with home discharge after rehabilitation among male veterans with lower extremity amputation. PM R 5:408-17
Bates, Barbara E; Hallenbeck, Richard; Ferrario, Toni et al. (2013) Patient-, treatment-, and facility-level structural characteristics associated with the receipt of preoperative lower extremity amputation rehabilitation. PM R 5:16-23
Kurichi, Jibby E; Vogel, W Bruce; Kwong, Pui L et al. (2013) Factors associated with total inpatient costs and length of stay during surgical hospitalization among veterans who underwent lower extremity amputation. Am J Phys Med Rehabil 92:203-14
Bates, Barbara E; Xie, Dawei; Kurichi, Jibby E et al. (2012) Revisiting risks associated with mortality following initial transtibial or transfemoral amputation. J Rehabil Res Dev 49:1479-92
Zhou, Jianxun; Bates, Barbara E; Kurichi, Jibby E et al. (2011) Factors influencing receipt of outpatient rehabilitation services among veterans following lower extremity amputation. Arch Phys Med Rehabil 92:1455-61
Kurichi, Jibby E; Xie, Dawei; Kwong, Pui L et al. (2011) Factors associated with late specialized rehabilitation among veterans with lower extremity amputation who underwent immediate postoperative rehabilitation. Am J Phys Med Rehabil 90:387-98
Stineman, Margaret G; Kwong, Pui L; Xie, Dawei et al. (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 2:232-43
Prvu-Bettger, Janet A; Bates, Barbara E; Bidelspach, Douglas E et al. (2009) Short- and long-term prognosis among veterans with neurological disorders and subsequent lower-extremity amputation. Neuroepidemiology 32:4-10

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