1
|
Wido D, Harrington CJ, Schulz RN, Jannace KC, Smith DG, Pasquina PF. Healthcare Utilization Following Hemipelvectomy or Hip Disarticulation in the Military Health System. Mil Med 2024; 189:e235-e241. [PMID: 37515572 DOI: 10.1093/milmed/usad295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/26/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023] Open
Abstract
INTRODUCTION Amputations at the hip and pelvic level are often performed secondary to high-energy trauma or pelvic neoplasms and are frequently associated with a prolonged postoperative rehabilitation course that involves a multitude of health care providers. The purpose of this study was to examine the health care utilization of patients with hip- and pelvic-level amputations that received care in the U.S. Military Health System. MATERIALS AND METHODS We performed a retrospective review of all patients who underwent a hip- or pelvic-level amputation in the Military Health System between 2001 and 2017. We compiled and reviewed all inpatient and outpatient encounters during three time points: (1) 3 months pre-amputation to 1 day pre-amputation, (2) the day of amputation through 12 months post-amputation, and (3) 13-24 months post-amputation. Health care utilization was defined as the average number of encounter days/admissions for each patient. Concomitant diagnoses following amputation including post-traumatic stress disorder, traumatic brain injury, anxiety, depression, and chronic pain were also recorded. RESULTS A total of 106 individuals with hip- and pelvic-level amputations were analyzed (69 unilateral hip disarticulation, 6 bilateral hip disarticulations, 27 unilateral hemipelvectomy, 2 bilateral hemipelvectomies, and 2 patients with a hemipelvectomy and contralateral hip disarticulation). Combat trauma contributed to 61.3% (n = 65) of all amputations. During the time period of 3 months pre-amputation, patients had an average of 3.8 encounter days. Following amputation, health care utilization increased in both the year following amputation and the time period of 13-24 months post-amputation, averaging 170.8 and 77.4 encounter days, respectively. Patients with trauma-related amputations averaged more total encounter days compared to patients with disease-related amputations in the time period of 12 months following amputation (203.8 vs.106.7, P < .001) and the time period of 13-24 months post-amputation (92.0 vs. 49.0, P = .005). PTSD (P = .02) and traumatic brain injuries (P < .001) were more common following combat-related amputations. CONCLUSIONS This study highlights the increased health care resource demand following hip- and pelvic-level amputations in a military population, particularly for those patients who sustained combat-related trauma. Additionally, patients with combat-related amputations had significantly higher rates of concomitant PTSD and traumatic brain injury. Understanding the extensive needs of this unique patient population helps inform providers and policymakers on the requirements for providing high-quality care to combat casualties.
Collapse
Affiliation(s)
- Daniel Wido
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Colin J Harrington
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Rebecca N Schulz
- The Center for Rehabilitation Sciences Research, Department of Physical Medicine & Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Kalyn C Jannace
- The Center for Rehabilitation Sciences Research, Department of Physical Medicine & Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Douglas G Smith
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- The Center for Rehabilitation Sciences Research, Department of Physical Medicine & Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Paul F Pasquina
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- The Center for Rehabilitation Sciences Research, Department of Physical Medicine & Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| |
Collapse
|
2
|
Resnik L, Borgia M, Ekerholm S, Highsmith MJ, Randolph BJ, Webster J, Clark MA. Amputation Care Quality and Satisfaction With Prosthetic Limb Services: A Longitudinal Study of Veterans With Upper Limb Amputation. Fed Pract 2021; 38:110-120. [PMID: 33859462 DOI: 10.12788/fp.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose This study sought to measure and identify factors associated with satisfaction with care among veterans. The metrics were colelcted for those receiving prosthetic limb care at the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) care settings and at community-based care providers. Methods A longitudinal cohort of veterans with major upper limb amputation receiving any VA care from 2010 to 2015 were interviewed by phone twice, 1 year apart. Care satisfaction was measured by the Orthotics and Prosthetics User's Survey (OPUS) client satisfaction survey (CSS), and prosthesis satisfaction was measured by the OPUS client satisfaction with device (CSD), and the Trinity Amputation and Prosthetic Experience Scale satisfaction scales. The Quality of Care index, developed for this study, assessed care quality. Bivariate analyses and multivariable linear regressions identified factors associated with CSS. Wilcoxon Mann-Whitney rank tests and Fisher exact tests compared CSS and Quality of Care items at follow-up for those with care within and outside of the VA and DoD. Results The study included 808 baseline participants and 585 follow-up participants. Device satisfaction and receipt of amputation care in the prior year were associated with greater satisfaction with care quality. Persons with bilateral amputation were significantly less satisfied with wait times. Veterans who received amputation care in the VA or DoD had better, but not statistically different, mean (SD) CSS scores: 31.6 (22.6) vs 39.4 (16.9), when compared with those who received care outside the VA or DoD. Those with care inside the VA or DoD were also more likely to have a functional assessment in the prior year (33.7% vs 7.1%, P = .06), be contacted by providers (42.7% vs 18.8%, P = .07), and receive amputation care information (41.6% vs 0%, P =.002). No statistically significant differences in CSS, Quality of Care scores, or pain measures were observed between baseline and follow-up. In regression models, those with higher CSD scores and with prior year amputation care had higher satisfaction when compared to those who had not received care. Conclusions Satisfaction with prosthetic limb care is associated with device satisfaction and receipt of care within the prior year. Veterans receiving amputation care within the VA or DoD received better care quality scores than those receiving prosthetic care outside of the VA or DoD. Satisfaction with care and quality of care were stable over the 12 months of this study. Findings from this study can serve as benchmarks for future work on care satisfaction and quality of amputation rehabilitative care.
Collapse
Affiliation(s)
- Linda Resnik
- is a Research Career Scientist at the US Department of Veterans Affairs (VA) Providence VA Medical Center (VAMC), and Professor of Health Services, Policy and Practice at Brown University in Rhode island, is a Biostatistician; and is a Program Manager in the Research Department, Providence VAMC. is an Adjunct Professor at University of Massachusetts Medical school in Worcester and Professor of Health Services Policy and Practice, Brown University. is a National Program Director at the VA Rehabilitation and Prosthetics Services, Orthotic & Prosthetic Clinical Services in Washington, DC and is Professor at the University of South Florida, Morsani College of Medicine, School of Physical Therapy & Rehabilitation Sciences in Tampa. is Deputy Director of the Extremity Trauma and Amputation Center of Excellence. is a Professor in the Department of Physical Medicine and Rehabilitation, School of Medicine at Virginia Commonwealth University and a Staff Physician, Physical Medicine and Rehabilitation Hunter Holmes McGuire VAMC in Richmond
| | - Matthew Borgia
- is a Research Career Scientist at the US Department of Veterans Affairs (VA) Providence VA Medical Center (VAMC), and Professor of Health Services, Policy and Practice at Brown University in Rhode island, is a Biostatistician; and is a Program Manager in the Research Department, Providence VAMC. is an Adjunct Professor at University of Massachusetts Medical school in Worcester and Professor of Health Services Policy and Practice, Brown University. is a National Program Director at the VA Rehabilitation and Prosthetics Services, Orthotic & Prosthetic Clinical Services in Washington, DC and is Professor at the University of South Florida, Morsani College of Medicine, School of Physical Therapy & Rehabilitation Sciences in Tampa. is Deputy Director of the Extremity Trauma and Amputation Center of Excellence. is a Professor in the Department of Physical Medicine and Rehabilitation, School of Medicine at Virginia Commonwealth University and a Staff Physician, Physical Medicine and Rehabilitation Hunter Holmes McGuire VAMC in Richmond
| | - Sarah Ekerholm
- is a Research Career Scientist at the US Department of Veterans Affairs (VA) Providence VA Medical Center (VAMC), and Professor of Health Services, Policy and Practice at Brown University in Rhode island, is a Biostatistician; and is a Program Manager in the Research Department, Providence VAMC. is an Adjunct Professor at University of Massachusetts Medical school in Worcester and Professor of Health Services Policy and Practice, Brown University. is a National Program Director at the VA Rehabilitation and Prosthetics Services, Orthotic & Prosthetic Clinical Services in Washington, DC and is Professor at the University of South Florida, Morsani College of Medicine, School of Physical Therapy & Rehabilitation Sciences in Tampa. is Deputy Director of the Extremity Trauma and Amputation Center of Excellence. is a Professor in the Department of Physical Medicine and Rehabilitation, School of Medicine at Virginia Commonwealth University and a Staff Physician, Physical Medicine and Rehabilitation Hunter Holmes McGuire VAMC in Richmond
| | - M Jason Highsmith
- is a Research Career Scientist at the US Department of Veterans Affairs (VA) Providence VA Medical Center (VAMC), and Professor of Health Services, Policy and Practice at Brown University in Rhode island, is a Biostatistician; and is a Program Manager in the Research Department, Providence VAMC. is an Adjunct Professor at University of Massachusetts Medical school in Worcester and Professor of Health Services Policy and Practice, Brown University. is a National Program Director at the VA Rehabilitation and Prosthetics Services, Orthotic & Prosthetic Clinical Services in Washington, DC and is Professor at the University of South Florida, Morsani College of Medicine, School of Physical Therapy & Rehabilitation Sciences in Tampa. is Deputy Director of the Extremity Trauma and Amputation Center of Excellence. is a Professor in the Department of Physical Medicine and Rehabilitation, School of Medicine at Virginia Commonwealth University and a Staff Physician, Physical Medicine and Rehabilitation Hunter Holmes McGuire VAMC in Richmond
| | - Billie Jane Randolph
- is a Research Career Scientist at the US Department of Veterans Affairs (VA) Providence VA Medical Center (VAMC), and Professor of Health Services, Policy and Practice at Brown University in Rhode island, is a Biostatistician; and is a Program Manager in the Research Department, Providence VAMC. is an Adjunct Professor at University of Massachusetts Medical school in Worcester and Professor of Health Services Policy and Practice, Brown University. is a National Program Director at the VA Rehabilitation and Prosthetics Services, Orthotic & Prosthetic Clinical Services in Washington, DC and is Professor at the University of South Florida, Morsani College of Medicine, School of Physical Therapy & Rehabilitation Sciences in Tampa. is Deputy Director of the Extremity Trauma and Amputation Center of Excellence. is a Professor in the Department of Physical Medicine and Rehabilitation, School of Medicine at Virginia Commonwealth University and a Staff Physician, Physical Medicine and Rehabilitation Hunter Holmes McGuire VAMC in Richmond
| | - Joseph Webster
- is a Research Career Scientist at the US Department of Veterans Affairs (VA) Providence VA Medical Center (VAMC), and Professor of Health Services, Policy and Practice at Brown University in Rhode island, is a Biostatistician; and is a Program Manager in the Research Department, Providence VAMC. is an Adjunct Professor at University of Massachusetts Medical school in Worcester and Professor of Health Services Policy and Practice, Brown University. is a National Program Director at the VA Rehabilitation and Prosthetics Services, Orthotic & Prosthetic Clinical Services in Washington, DC and is Professor at the University of South Florida, Morsani College of Medicine, School of Physical Therapy & Rehabilitation Sciences in Tampa. is Deputy Director of the Extremity Trauma and Amputation Center of Excellence. is a Professor in the Department of Physical Medicine and Rehabilitation, School of Medicine at Virginia Commonwealth University and a Staff Physician, Physical Medicine and Rehabilitation Hunter Holmes McGuire VAMC in Richmond
| | - Melissa A Clark
- is a Research Career Scientist at the US Department of Veterans Affairs (VA) Providence VA Medical Center (VAMC), and Professor of Health Services, Policy and Practice at Brown University in Rhode island, is a Biostatistician; and is a Program Manager in the Research Department, Providence VAMC. is an Adjunct Professor at University of Massachusetts Medical school in Worcester and Professor of Health Services Policy and Practice, Brown University. is a National Program Director at the VA Rehabilitation and Prosthetics Services, Orthotic & Prosthetic Clinical Services in Washington, DC and is Professor at the University of South Florida, Morsani College of Medicine, School of Physical Therapy & Rehabilitation Sciences in Tampa. is Deputy Director of the Extremity Trauma and Amputation Center of Excellence. is a Professor in the Department of Physical Medicine and Rehabilitation, School of Medicine at Virginia Commonwealth University and a Staff Physician, Physical Medicine and Rehabilitation Hunter Holmes McGuire VAMC in Richmond
| |
Collapse
|
3
|
Melcer T, Walker J, Sazon J, Domasing R, Perez K, Bhatnagar V, Galarneau M. Outpatient Pharmacy Prescriptions During the First Year Following Serious Combat Injury: A Retrospective Analysis. Mil Med 2020; 185:e1091-e1100. [PMID: 32175572 DOI: 10.1093/milmed/usaa038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/19/2019] [Accepted: 02/10/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Limited research has analyzed the full range of outpatient medication prescription activity following serious combat injury. The objectives of this study were to describe (1) outpatient medication prescriptions and refills during the first 12 months after serious combat injury, (2) longitudinal changes in medication prescriptions during the first-year postinjury, and (3) patient characteristics associated with outpatient prescriptions. MATERIALS AND METHODS This was a retrospective analysis of existing health and pharmacy data for a random sample of U.S. service members who sustained serious combat injuries in the Iraq and Afghanistan conflicts, 2010-2013 (n = 381). Serious injury was defined by an Injury Severity Score (ISS) of 9 or greater. These patients typically participate in military rehabilitation programs (eg, amputation care) where prescription medications are essential. Data sources were the Expeditionary Medical Encounter Database for injury-specific data, the Pharmacy Data Transaction Service for outpatient medication prescriptions and refills, and the Military Health System Data Repository for diagnostic codes of pain and psychological disorders. Military trauma nurses reviewed casualty records to identify types of injuries. Using the American Hospital Formulary Service Pharmacologic-Therapeutic Classification system, clinicians identified 13 categories of prescription medications (eg, opioid, psychotherapeutic, immunologic) for analysis. Multivariable negative binomial and logistic regression analyses evaluated significant associations between independent variables (eg, blast injury, traumatic brain injury [TBI], ISS, limb amputation, diagnoses of chronic pain, or psychological disorders) and prescription measures (ie, number or category of medication prescriptions). We also describe longitudinal changes in prescription activity postinjury across consecutive quarterly intervals (91 days) during the first-year postinjury. RESULTS During the first-year postinjury, patients averaged 61 outpatient prescriptions, including all initial prescriptions and refills. They averaged eight different categories of medications, primarily opioid, immunologic, gastrointestinal/genitourinary, central nervous system (CNS), nonopioid analgesic, and psychotherapeutic medications (representing 82% of prescriptions) during the first year. Prescription activity generally declined across quarters. There was still substantial prescription activity during the fourth quarter, as 79% of patients had at least one prescription. From 39 to 49% of patients had fourth-quarter prescriptions for opioid, CNS, or psychotherapeutic medications. Longitudinally, we found that 24-34% of patients had an opioid, CNS, or psychotherapeutic prescription during each of the final three quarters. In multivariable analysis, ISS, limb amputation (particularly bilateral amputation), and diagnoses of chronic pain and post-traumatic stress disorder (PTSD) were associated with significantly higher counts of individual and multiple medication prescriptions. TBI was associated with significantly lower numbers of prescriptions for certain medications. CONCLUSIONS This is one of the first studies to provide a systematic analysis of outpatient medication prescriptions following serious combat injury. The results indicate substantial prescription activity from multiple medication categories throughout the first-year postinjury. Diagnoses of chronic pain, PTSD, and limb amputation and ISS were associated with significantly higher counts of prescriptions overall and more prescription medication categories. This study provides initial evidence to better understand medication prescription activity following serious combat injury. The results inform future research on medication prescription practices and planning for rehabilitation.
Collapse
Affiliation(s)
- Ted Melcer
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521
| | - Jay Walker
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521.,Leidos, Inc., 140 Sylvester Road, San Diego, CA 92106-3521
| | - Jocelyn Sazon
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521.,Axiom Resource Management, Inc., 140 Sylvester Road, San Diego, CA 92106-3521
| | - Robby Domasing
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521.,Axiom Resource Management, Inc., 140 Sylvester Road, San Diego, CA 92106-3521
| | - Katheryne Perez
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521.,Leidos, Inc., 140 Sylvester Road, San Diego, CA 92106-3521
| | - Vibha Bhatnagar
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161.,Department for Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093
| | - Michael Galarneau
- Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106-3521
| |
Collapse
|