退伍军人事务设施中专门康复单元的存在是否会影响下肢截肢后康复护理的转诊？
Does the presence of a specialized rehabilitation unit in a Veterans Affairs facility impact referral for rehabilitative care after a lower-extremity amputation?
作者信息
Bates Barbara E, Kurichi Jibby E, Marshall Clifford R, Reker Dean, Maislin Greg, Stineman Margaret G
机构信息
Physical Medicine Service, VAMC Albany, NY 12208, USA.
出版信息
Arch Phys Med Rehabil. 2007 Oct;88(10):1249-55. doi: 10.1016/j.apmr.2007.06.018.
OBJECTIVE
To determine if the presence of specialized rehabilitation units (SRUs) within Veterans Affairs medical centers (VAMC) influences access to rehabilitation services.
DESIGN
Retrospective cohort analysis.
SETTING
Two types of VAMCs: those with and without SRUs.
PARTICIPANTS
Veterans with lower-extremity amputations discharged from VAMCs between October 1, 2002, and September 30, 2003. There were a total of 2375 veterans with amputations: 99% were men; and 60% had transtibial, 40% had transfemoral, and less than 1% had hip disarticulation amputations. Nine hundred sixty-six patients (41%) were seen at a VAMC with an SRU.
INTERVENTIONS
Not applicable.
MAIN OUTCOME MEASURE
Level of service provided expressed as: no evidence of rehabilitation during the hospitalization, generalized rehabilitation through consultation only, or admission to an SRU.
RESULTS
There were no differences between patients treated at facilities with SRUs and those treated in a facility without SRU beds with respect to age, sex, marital status, source of hospital admission, or level of amputation (all P<.05). Patients with lower initial FIM instrument scores were more likely to be treated in facilities with SRUs, and to have longer lengths of acute hospitalization (P<.01). Patients at facilities with an SRU compared with those without an SRU had comparable likelihoods of being seen for an initial rehabilitation consultation (75% vs 74%, P=.56), but were more likely to be admitted for high intensity specialty rehabilitation services (26% vs 11%, P<.01).
CONCLUSIONS
Although the majority of patients were seen in consultation, structural differences in service availability among clinically similar populations appear to be causing access disparities to specialized rehabilitation among amputees in the VAMC setting. The implication of these differences with regard to patient outcomes will need to be determined.
目的
确定退伍军人事务医疗中心（VAMC）内专科康复单元（SRU）的存在是否会影响康复服务的可及性。
设计
回顾性队列分析。
设置
两类VAMC：设有和未设有SRU的。
参与者
2002年10月1日至2003年9月30日期间从VAMC出院的下肢截肢退伍军人。共有2375名截肢退伍军人：99%为男性；60%为经胫骨截肢，40%为经股骨截肢，不足1%为髋关节离断截肢。966名患者（41%）在设有SRU的VAMC接受治疗。
干预措施
不适用。
主要结局指标
所提供的服务水平表示为：住院期间无康复迹象、仅通过会诊进行一般康复或入住SRU。
结果
在设有SRU的机构接受治疗的患者与在没有SRU床位的机构接受治疗的患者在年龄、性别、婚姻状况、入院来源或截肢水平方面均无差异（所有P<0.05）。初始FIM工具评分较低的患者更有可能在设有SRU的机构接受治疗，且急性住院时间更长（P<0.01）。与没有SRU的机构相比，设有SRU的机构的患者接受初次康复会诊的可能性相当（75%对74%，P = 0.56），但更有可能被收治接受高强度专科康复服务（26%对11%，P<0.01）。
结论
尽管大多数患者接受了会诊，但临床相似人群中服务可及性的结构差异似乎导致了VAMC环境中截肢患者获得专科康复的机会不平等。这些差异对患者结局的影响有待确定。
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