全球智库信息集成服务系统

After September 11, 2001, the military sought to build a new system of care for combat amputees

• The system included a new team approach to patient care.
• The system included establishment of three advanced rehabilitation centers and the Extremity Trauma and Amputation Center of Excellence.
• The system included the goals of returning patients to their pre-injury level of activity and giving them the option to remain on active duty.

Interviews with providers who have provided care to patients with amputation revealed six key competencies and associated behaviors, which can be used as a basis for further training, education, and professional development

• These key competencies are teamwork, patient and family education, military and other cultural awareness, patient-centered care, evidence-based practice, and ethical and professional behavior.

These core competencies apply to nine services

• These services are behavioral health, biomedical engineering, case management, diet/nutrition, occupational therapy, orthopaedic surgery, physical therapy, physical medicine and rehabilitation, and prosthetics and orthotics.

Since September 11, 2001, the Department of Defense (DOD) has rehabilitated more than 2,000 service members and veterans who experienced one or more deployment-related amputation(s), with the number of new amputations peaking in 2011. As a consequence of lower deployment, the number of new amputations has shrunk in each subsequent year, bringing with it the risk that provider skills will atrophy. In order to prevent this and to capture best practices, knowledge, and skills that were developed by DOD during the conflicts in Iraq and Afghanistan, RAND Arroyo Center researchers interviewed providers working in military treatment facilities to identify a set of services that are integral to optimal amputation rehabilitation. These services are behavioral health, biomedical engineering, case management, diet/nutrition, occupational therapy, orthopaedic surgery, physical therapy, physical medicine and rehabilitation, and prosthetics and orthotics. For those nine services, the researchers defined and documented the core competencies that are needed by health care provides who offer those services, as well as behaviors that demonstrate that a provider has the competency. The competencies common to all nine services fall into the following categories: teamwork, patient and family education, military and other cultural awareness, patient-centered care, evidence-based practice, and ethical and professional behavior. Using technical expert surveys, researchers asked providers in each service area to discuss their use and understanding of the core competencies, along with means for evaluating them, and then developed recommendations for how to adopt and implement them in the military health setting.

• Chapter One

  Introduction

• Chapter Two

  Amputation Rehabilitation Since September 11, 2001

• Chapter Three

  Developing a Competency Model: Interviews and Technical Expert Surveys

• Chapter Four

  Best Practices in Civilian Amputee Care for DOD Consideration

• Chapter Five

  Conclusions and Recommendations

• Appendix A

  Context of Battlefield Amputations

• Appendix B

  Studies of Patient Outcomes and Examples of Recent Technological Advancements in Amputation Rehabilitation

• Appendix C

  Interview Guides

• Appendix D

  Codebook for Qualitative Analysis

• Appendix E

  Results of the Technical Expert Survey

• Appendix F

  Training and Education in Amputation Rehabilitation