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.
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