Does the Presence of a Specialized Rehabilitation Unit in a Veterans Affairs Facility Impact Referral for Rehabilitative Care After a Lower-Extremity Amputation?

Bates, Barbara; Kurichi, Jibby E.; Marshall, C.; Reker, Dean M.; Maislin, Greg; Stineman, Margaret G.

doi:10.1016/j.apmr.2007.06.018

Cited by 20 publications

(18 citation statements)

References 20 publications

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“…The TPT framework is supported by previous findings [8‐10] that patient complexity, as well as structural elements, influence both the types of rehabilitation received by patients and their outcomes in stroke and amputation. The decision as to whether patients receive specialized or consultative rehabilitation relates to clinical traits.…”

Section: Introductionsupporting

confidence: 60%

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

Stineman

Kwong

Xie

et al. 2010

PM&R

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Objective To compare the recovery of mobility and self-care functions among veteran amputees according to the timing and type of rehabilitation services received. Design Observational study of inpatient rehabilitation care patterns of 2 types (specialized and consultative) with 2 timings (early and late). Setting Data from inpatient specialized rehabilitation units (SRUs) and consultative services within 95 Veterans Affairs Medical Centers across the United States during fiscal years 2003-2004. Patients Medical records of 1,502 patients who received early or late consultative or specialized rehabilitation. Assessment of risk factors Hypotheses were established and general categories of negative and positive risk factors specified a priori from available clinical characteristics. Linear mixed effects models were used to model motor Functional Independence Measure (FIM™) gain scores on patient-level variables accounting for the correlation within the same facility. Main outcome measures Recovery of activities of daily living (ADLs) and mobility (physical functioning) expressed as the magnitudes of gains in motor FIM™ scores achieved by rehabilitation discharge. Results After adjustment, amputees who received specialized rehabilitation had motor FIM™ gains that were on average 8.0 points higher than those amputees who received consultative rehabilitation. Although patients whose rehabilitation was delayed until after discharge from the index surgical stay tended to be more clinically complex, they had comparable gains to patients who received early rehabilitation. Advanced age, trans-femoral amputation, paralysis, serious nutritional compromise, and psychosis were associated with lower motor FIM™ gains. The variance for the random effect for facility was statistically significant, suggesting extraneous variation within facility that was not explainable by observed patient-level variables. Conclusion Based on this analysis, those patients who receive specialized rehabilitation can be expected to make comparatively higher gains than patients who receive consultative services, regardless of timing and clinical complexity. Findings highlight the need for clinicians to adjust prognostic expectations to both clinical severity and the type of rehabilitation patients receive.

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Section: Introductionsupporting

confidence: 60%

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

Stineman

Kwong

Xie

et al. 2010

PM&R

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“…These databases captured various aspects of the Veterans' healthcare utilization. The data sources and how the data were used have been described previously [10][11][12][13][14][15][16][17]. Travel time to the nearest hospital was calculated using the 2007 American Hospital Association (AHA) Annual Survey Database for hospital location and the Veterans' ZIP code of residence from the Medical SAS Datasets.…”

Section: Sources Of Datamentioning

confidence: 99%

Prosthetic fitting, use, and satisfaction following lower-limb amputation: A prospective study

Webster¹,

Hakimi²,

Williams³

et al. 2012

JRRD

133

106

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Abstract-This study's objective was to determine how treatment-, environmental-, and facility-level characteristics contribute to postdischarge mortality prediction. The study included 4,153 Veterans who underwent lower-limb amputation in Department of Veterans Affairs facilities during fiscal years 2003 and 2004. Veterans were followed 1 yr postamputation. A Cox regression identified characteristics associated with mortality risk after hospital discharge following amputation. Older age, higher amputation level, and more comorbidities increased mortality likelihood. Patients who had inpatient procedures for pulmonary and renal problems had higher hazards of postdischarge death than those who did not (hazard ratio [HR] = 2.10, 95% confidence interval [CI] = 1.16-3.77, and HR = 2.22, 95% CI = 1.80-2.74, respectively). Patients who had central nervous system procedures had higher hazards of death early postdischarge (HR = 2.23, 95% CI = 1.60-3.11) at 0 d, but this association became insignificant by 180 d. Patients in a surgical intensive care unit (ICU), medical ICU, or medical bed section at the time of discharge were more likely to die than patients on a surgical bed section. Patients hospitalized in the Midwest were less likely to die early after discharge than patients in the Mountain Pacific region, but this regional effect became insignificant by 90 d. Adding treatment-, environmental-, and facility-level characteristics contributed additional information to a mortality risk model.

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“…The databases included 4 inpatient datasets referred to as the Patient Treatment Files (PTFs; main, procedure, bed section, and surgery) [8], 2 outpatient care files (visit and event) [9], and the FSOD [10]. The databases and our methods of data extraction have been described previously [11‐14].…”

Section: Methodsmentioning

confidence: 99%

Patient‐, Treatment‐, and Facility‐Level Structural Characteristics Associated With the Receipt of Preoperative Lower Extremity Amputation Rehabilitation

Bates

Hallenbeck

Ferrario

et al. 2012

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Objectives To determine patient, treatment, or facility characteristics that influence decisions to initiate a rehabilitation assessment before transtibial or transfemoral amputation within the Veterans Affairs (VA) health care system. Design Retrospective database study. Setting VA medical centers. Participants A total of 4226 veterans with lower extremity amputations discharged from a VA medical center between October 1, 2002, and September 30, 2004. Outcome Evidence of a preoperative rehabilitation assessment after the index surgical stay admission but before the surgical date. Results Evidence was found that 343 of 4226 veterans (8.12%) with lower extremity amputations received preoperative rehabilitation assessments. Veterans receiving preoperative rehabilitation were more likely to be older, admitted from home, or transferred from another hospital. Patients who underwent surgical amputation at smaller-sized hospitals or in the South Central or Mountain Pacific regions were more likely to receive preoperative rehabilitation compared with patients in mid-sized hospitals or in the Northeast, Southeast, or Midwest regions. Patients with evidence of paralysis, patients treated in facilities with programs accredited by the Commission on Accreditation of Rehabilitation Facilities (P < .01), and patients in the second data wave were less likely to receive preoperative rehabilitation. After accounting for patient-, treatment-, and facility-level structural characteristics, we found that older patients were more likely to receive preoperative rehabilitation services (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.01–1.02). Patients with a contributing amputation etiology of a previous amputation complication were more likely to receive preoperative consultation rehabilitation services (OR 1.50, 95% CI 1.02–2.19) compared with patients who did not have this etiology. Compared with patients treated in the Southeast region of the United States, those treated in the South Central region (OR 2.52, 95% CI 1.82–3.48) or Mountain Pacific region (OR 1.62, 95% CI 1.11–2.37) were more likely to receive preoperative consultation rehabilitation services. Patients with evidence of paralysis were less likely to receive preoperative rehabilitative services compared with patients who did not have this condition (OR 0.29, 95% CI 0.09–0.93), and patients treated in mid-sized hospitals also were less likely to receive preoperative rehabilitative services compared with patients treated in smaller-sized facilities (OR 0.38, 95% CI 0.27–0.53). Veterans in the second data year were less likely to receive services compared with patients in the first year (OR 0.74, 95% CI 0.58–0.94). Conclusions Rehabilitation assessment before lower extremity amputation surgery is a rare occurrence in the VA health care system. Practice patterns appear to be driven by location and not by patient characteristics.

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Does the Presence of a Specialized Rehabilitation Unit in a Veterans Affairs Facility Impact Referral for Rehabilitative Care After a Lower-Extremity Amputation?

Cited by 20 publications

References 20 publications

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

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

Prosthetic fitting, use, and satisfaction following lower-limb amputation: A prospective study

Patient‐, Treatment‐, and Facility‐Level Structural Characteristics Associated With the Receipt of Preoperative Lower Extremity Amputation Rehabilitation

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