Expert Panel recommendations-Based on research and deliberations from VA HSR&amp;D project "Impact of the DOD paradigm shift on VA amputee prosthetic care"

Reiber, Gayle E.

doi:10.1682/jrrd.2010.03.0031

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…Notably, while the majority of index TKAs performed in VA that resulted in a readmission were readmitted to VA, fewer index CC TKA surgeries that resulted in a readmission returned to the same setting of care (CC) as their index surgery; the remainder went to either a VA or community hospital reimbursed by Medicare. As noted in the literature, such dual-system use could lead to fragmentation of care and/or adverse outcomes 3,45,46. Although adding in the Medicare data contributed to the capture of readmissions outside VA especially for CC, the 3-year delay in obtaining cleaned Medicare data makes it impractical to use these data for tracking quality of care between VA and CC on a real-time basis.…”

Section: Discussionmentioning

confidence: 99%

Comparing Postoperative Readmission Rates Between Veterans Receiving Total Knee Arthroplasty in the Veterans Health Administration Versus Community Care

et al. 2021

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Background: There are growing concerns that Veterans' increased use of Veterans Health Administration (VA)-purchased care in the community may lead to lower quality of care.Objective: We compared rates of hospital readmissions following elective total knee arthroplasties (TKAs) that were either performed in VA or purchased by VA through community care (CC) at both the national and facility levels.Methods: Three-year cohort study using VA and CC administrative data from the VA's Corporate Data Warehouse (October 1, 2016-September 30, 2019). We obtained Medicare data to capture readmissions that were paid by Medicare. We used the Centers for Medicare and Medicaid Services (CMS) methods to identify unplanned, 30-day, all-cause readmissions. A secondary outcome, TKA-related readmissions, identified readmissions resulting from complications of the index surgery. We ran mixed-effects logistic regression models to compare the risk-adjusted odds of all-cause and TKA-related readmissions between TKAs performed in VA versus CC, adjusting for patients' sociodemographic and clinical characteristics.Principal Findings: Nationally, the odds of experiencing an allcause or TKA-related readmission were significantly lower for TKAs performed in VA versus CC (eg, the odds of experiencing an all-cause readmission in VA were 35% of those in CC. At the facility level, most VA facilities performed similarly to their corresponding CC providers, although there were 3 VA facilities that performed worse than their corresponding CC providers.Conclusions: Given VA's history in providing high-quality surgical care to Veterans, it is important to closely monitor and track whether the shift to CC for surgical care will impact quality in both settings over time.

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Section: Discussionmentioning

confidence: 99%

Comparing Postoperative Readmission Rates Between Veterans Receiving Total Knee Arthroplasty in the Veterans Health Administration Versus Community Care

et al. 2021

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Servicemembers and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: Survey methods, participants, and summary findings

Reiber¹,

McFarland²,

Hubbard³

et al. 2010

JRRD

162

167

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Abstract-Care of veterans and servicemembers with major traumatic limb loss from combat theaters is one of the highest priorities of the Department of Veteran Affairs. We achieved a 62% response rate in our Survey for Prosthetic Use from 298 Vietnam war veterans and 283 servicemembers/veterans from Operation Iraqi Freedom/Operation Enduring Freedom (OIF/ OEF) who sustained major traumatic limb loss. Participants reported their combat injuries; health status; quality of life; and prosthetic device use, function, rejection, and satisfaction. Despite the serious injuries experienced, health status was rated excellent, very good, or good by 70.7% of Vietnam war and 85.5% of OIF/OEF survey participants. However, many health issues persist for Vietnam war and OIF/OEF survey participants (respectively): phantom limb pain (72.2%/76.0%), chronic back pain (36.2%/42.1%), residual-limb pain (48.3%/ 62.9%), prosthesis-related skin problems (51.0%/58.0%), hearing loss (47.0%/47.0%), traumatic brain injury (3.4%/33.9%), depression (24.5%/24.0%), and posttraumatic stress disorder (37.6%/58.7%). Prosthetic devices are currently used by 78.2% of Vietnam war and 90.5% of OIF/OEF survey participants to improve function and mobility. On average, the annual rate for prosthetic device receipt is 10.7-fold higher for OIF/OEF than for Vietnam war survey participants. Findings from this crossconflict survey identify many strengths in prosthetic rehabilitation for those with limb loss and several areas for future attention.

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VA paradigm shift in care of veterans with limb loss

Reiber¹,

Smith²

2010

JRRD

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Expert Panel recommendations-Based on research and deliberations from VA HSR&D project "Impact of the DOD paradigm shift on VA amputee prosthetic care"

Cited by 3 publications

References 9 publications

Comparing Postoperative Readmission Rates Between Veterans Receiving Total Knee Arthroplasty in the Veterans Health Administration Versus Community Care

Comparing Postoperative Readmission Rates Between Veterans Receiving Total Knee Arthroplasty in the Veterans Health Administration Versus Community Care

Servicemembers and veterans with major traumatic limb loss from Vietnam war and OIF/OEF conflicts: Survey methods, participants, and summary findings

VA paradigm shift in care of veterans with limb loss

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