Department of Veterans Affairs Amputation System of Care: 5 years of accomplishments and outcomes

Webster, Joseph B.; Poorman, Cindy E.; Cifu, David X.

doi:10.1682/jrrd.2014.01.0025

Cited by 22 publications

(17 citation statements)

References 7 publications

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“…While other countries have socialized medical models, various nations’ approaches to the provision of socialized health care differ considerably. For comparison, the Veterans Affairs Amputation System of Care (VA ASoC) is a U.S. government (i.e., public) sector health care system charged with providing care for the unique population of military service Veterans with limb loss (28). The VA ASoC’s mission differs considerably from socialized models charged with care provision for an entire country’s population, and there is no clear private sector alternative to compare outcomes within the U.S.…”

Section: Discussionmentioning

confidence: 99%

Economic Evaluations of Interventions For Transtibial Amputees: A Scoping Review of Comparative Studies

et al. 2016

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Transtibial amputation (TTA) is life-altering emotionally, functionally, and economically. The economic impact to all stakeholders is largely unknown, as is the cost-effectiveness of prosthetic intervention. This scoping report’s purpose was to determine if there is sufficient evidence to conduct a formal systematic review or meta-analysis in any particular prosthetic intervention area and to determine if any evidence statements could be synthesized relative to economic evaluation of interventions provided to patients with TTA. The scoping review revealed six articles representing three topical areas of transtibial care: Care Models, Prosthetic Treatment, and Prosthetic Sockets. All six articles were cost-identification or cost-consequence design and included a total of 704 subjects. Presently, it can be concluded with moderate confidence that specific weight-bearing and total-contact sockets for transtibial amputees are functionally and economically equivalent in the short term when costs, delivery time, and all stakeholder perspectives are considered. Long-term socket outcomes are relatively unexplored. Further primary research is needed beyond this to determine cost-effectiveness for other areas of transtibial prosthetic care although clinical outcomes are somewhat established through systematic review and meta-analysis in other areas of care. Conversely, evaluation of narrative economic reports relative to transtibial care may be sufficient to warrant further analysis. Guidance from the profession may also be useful in devising a strategy for how to assure economic analyses are a routine element of future prosthetic science.

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Section: Discussionmentioning

confidence: 99%

Economic Evaluations of Interventions For Transtibial Amputees: A Scoping Review of Comparative Studies

et al. 2016

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“…Through the provision of quality rehabilitation and prosthetic limb care, the ASoC strives to minimize disability and enable the highest level of social, vocational, and recreational success for veterans with an amputation. [1][2][3] The policy and procedures for the ASoC have been detailed in prior VA Handbooks and in the ASoC Directive. 1 This article highlights the background, population served, and organizational structure of the ASoC by detailing the outcomes and accomplishments of this systems-based approach to longitudinal amputation care between 2009 and 2019.…”

Section: Amputation System Of Carementioning

confidence: 99%

“…The ASoC is an integrated, national health care delivery system in which each VA medical center (VAMC) has a specific designation that reflects the level of expertise and accessibility across the system based on an individual veteran's needs and the specific capabilities of each VAMC. [1][2][3] The organizational structure for the ASoC is similar to the Polytrauma System of Care in that facilities are divided into 4 tiers. 1,4 For the ASoC, the 4 tiers are Regional Amputation Centers (RAC) at 7 VAMCs, Polytrauma Amputation Network Sites (PANS) at 18 VAMCs, Amputation Clinic Teams (ACT) at 106 VAMCs, and Amputation Points of Contact (APoC) at 22 VAMCs.…”

Section: Organizational Structurementioning

confidence: 99%

“…Comprehensive management of veterans with limb loss includes addressing VA Amputation Care medical considerations such as residual limb skin health to the prescription of artificial limbs and the provision of therapy services for prosthetic limb gait training. 1,2 Lifelong care for veterans living with limb loss is another hallmark of the ASoC. The provision of care coordination across the continuum of care from acute hospitalization following an amputation to long-term follow-up in the outpatient setting for veteran's lifespan is essential.…”

Section: Organizational Structurementioning

confidence: 99%

“…he US Department of Veterans Affairs (VA) established a formal Amputation System of Care (ASoC) in 2008 with the goal of enhancing the quality and consistency of amputation rehabilitation care for veterans with limb loss. 1,2 Throughout its history, the VA has placed a high priority on the care that is provided to veterans with limb amputation. 1,3 Amputations have medical, physical, social, and psychological ramifications for the veteran and his or her family.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Ten-Year Outcomes of a Systems-Based Approach to Longitudinal Amputation Care in the US Department of Veteran Affairs

Webster¹,

Scholten²,

Young³

et al. 2020

Federal Practitioner

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Descriptive Analysis of Types and Diagnoses Associated with Lower Extremity Amputation: Analysis of the US Veterans Health Administration Database 2019–2023

Lal,

Gao,

et al. 2024

Adv Ther

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Introduction Veterans in the US have higher rates of lower extremity amputation (LEA) compared to the general population and these rates have increased between 2008 and 2018. There is limited data which directly evaluate the potential underlying comorbidities associated with LEA in the veterans’ population especially with the most recent data. Such information is critical to help inform clinical management strategies to reduce the risk of amputations among our veterans. Methods This was a retrospective observational study of adults in the Veterans Health Administration database who underwent LEA from January 1, 2019 to December 31, 2023. The date of the first LEA procedure was defined as the index date. Index LEA type, patient demographic at baseline, and clinical characteristics (including diagnoses for conditions associated with LEA and other comorbidities) 1 year before and 30 days after the index LEA procedure (except for bacterial infections which the identification period was 30 days before and 30 days after the index LEA procedure) were described. Results Of the 27,134 Veterans with LEA, 67.3% were ≥ 65 years of age, 97.0% were male, and 65.3% were non-Hispanic white. The most common type of LEA was transmetatarsal (52.9%), followed by toe (21.9%), above-knee (15.4%), and below-knee (9.8%). The most prevalent diagnoses associated with LEA were diabetes (81.6%), bacterial infections (79.1%), and peripheral artery disease (PAD; 63.3%). Only 15 Veterans (< 0.1%) had a diagnosis for combat-related injuries to lower extremities. Conclusion Diabetes and PAD are highly prevalent and among the main conditions associated with LEA among US Veterans. Earlier and more effective preventative and clinical management of these conditions offer an opportunity to significantly reduce the rates of LEA in this population. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-024-03005-6.

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Department of Veterans Affairs Amputation System of Care: 5 years of accomplishments and outcomes

Cited by 22 publications

References 7 publications

Economic Evaluations of Interventions For Transtibial Amputees: A Scoping Review of Comparative Studies

Economic Evaluations of Interventions For Transtibial Amputees: A Scoping Review of Comparative Studies

Ten-Year Outcomes of a Systems-Based Approach to Longitudinal Amputation Care in the US Department of Veteran Affairs

Descriptive Analysis of Types and Diagnoses Associated with Lower Extremity Amputation: Analysis of the US Veterans Health Administration Database 2019–2023

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