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.
