title: Does the presence of a specialized rehabilitation unit in a Veterans Affairs facility impact referral for rehabilitative care after a lower-extremity amputation?
abstract: OBJECTIVE
  To determine if the presence of specialized rehabilitation units (SRUs) within Veterans Affairs medical centers (VAMC) influences access to rehabilitation services.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Two types of VAMCs: those with and without SRUs.
  
  
  METHODS
  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.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: Physical Medicine Service, VAMC Albany, NY 12208, USA. barbara.bates@va.gov
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Bates
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.forename: Clifford R
authors.initials: CR
authors.lastname: Marshall
authors.forename: Dean
authors.initials: D
authors.lastname: Reker
authors.forename: Greg
authors.initials: G
authors.lastname: Maislin
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D035002:Lower Extremity; D008297:Male; D012047:Rehabilitation Centers / Q000458:organization & administration*; D012189:Retrospective Studies; D014481:United States