Resnik Linda, Borgia Matthew, Ekerholm Sarah, Highsmith M Jason, Randolph Billie Jane, Webster Joseph, Clark Melissa A
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.
Fed Pract. 2021 Mar;38(3):110-120. doi: 10.12788/fp.0096.
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.
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.
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%, = .06), be contacted by providers (42.7% vs 18.8%, = .07), and receive amputation care information (41.6% vs 0%, =.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.
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.
本研究旨在测量并确定与退伍军人护理满意度相关的因素。收集了在美国退伍军人事务部（VA）、美国国防部（DoD）医疗机构以及社区护理机构接受假肢护理的人员的相关指标。
对2010年至2015年期间接受任何VA护理的上肢主要截肢退伍军人进行纵向队列研究，通过电话进行两次访谈，间隔1年。护理满意度通过矫形器和假肢使用者调查（OPUS）客户满意度调查（CSS）进行测量，假肢满意度通过OPUS设备客户满意度（CSD）以及三一截肢与假肢体验量表满意度量表进行测量。为本研究开发的护理质量指数评估护理质量。双变量分析和多变量线性回归确定与CSS相关的因素。Wilcoxon Mann-Whitney秩和检验以及Fisher精确检验比较了在VA和DoD内部及外部接受护理的人员在随访时的CSS和护理质量项目。
该研究纳入了808名基线参与者和585名随访参与者。设备满意度和上一年接受截肢护理与更高的护理质量满意度相关。双侧截肢者对等待时间的满意度明显较低。在VA或DoD接受截肢护理的退伍军人的平均（标准差）CSS得分更高，但无统计学差异：与在VA或DoD外部接受护理的退伍军人相比，分别为31.6（22.6）和39.4（16.9）。在VA或DoD内部接受护理的人员在上一年也更有可能接受功能评估（33.7%对7.1%，P = 0.06）、与提供者联系（42.7%对18.8%，P = 0.07）以及获得截肢护理信息（41.6%对0%，P = 0.002）。在基线和随访之间，CSS、护理质量得分或疼痛测量方面未观察到统计学上的显著差异。在回归模型中，与未接受护理的人员相比，CSD得分较高且上一年接受截肢护理的人员满意度更高。
假肢护理满意度与设备满意度和上一年接受护理情况相关。在VA或DoD接受截肢护理的退伍军人的护理质量得分高于在VA或DoD外部接受假肢护理的人员。在本研究的12个月期间，护理满意度和护理质量保持稳定。本研究结果可作为未来护理满意度和截肢康复护理质量工作的基准。
