Department of Veterans Affairs Amputation System of Care: 5 years of accomplishments and outcomes

Abstract

INTRODUCTION For more than 150 years, the Department of Veterans Affairs (VA) has held the care provided to Veterans with limb amputations as a high priority. To many Americans, the Veteran with an amputation epitomizes the sacrifices made on our nation's behalf. The VA is dedicated to providing optimal care for these individuals in order to restore function and improve quality of life. This commitment has been reaffirmed over time through the passage of key legislation such as the Veterans Medical Programs Amendments of 1992 and the Veterans Health Care Eligibility Act of 1996 [1]. The life-changing effect of amputation on Veterans has also been acknowledged through the VA's long-standing commitment to amputation prevention programs [2]. In 2008, after years of planning and preparation, VA approved and began implementing the Amputation System of Care (ASoC) in order to enhance the quality and consistency of care provided to the Veteran with limb loss. In 2010, Dr. Sigford described this paradigm shift in VA amputation care and the implementation plan for the ASoC [3]. The driving force behind this program was the need to provide lifelong care for servicemembers with combat-related amputations from the military conflicts in Iraq and Afghanistan and for Veterans with amputations from diseases such as diabetes and peripheral vascular disease. The system is designed to provide the latest practices in medical care, prosthetic technology, and rehabilitation management in order to assist individuals with amputations in reaching their highest level of functional independence. In this article, we highlight the accomplishments and outcomes of the ASoC in the domains of program scope, organizational structure, clinical services, and additional performance metrics 5 yr after initial program implementation. PROGRAM SCOPE, ORGANIZATIONAL STRUCTURE, AND EVOLUTION The ASoC is an integrated, national healthcare delivery system. It provides patient-centered, gender-sensitive, age-appropriate, life-long, holistic care and care coordination for Veterans with limb amputations. Through the provision of quality rehabilitation and prosthetic care, the ASoC minimizes disability and enables the highest level of social, vocational, and recreational reintegration. The ASoC provides specialized expertise in amputation care through incorporating the latest practices in medical rehabilitation, therapy services, and prosthetic technology. This specialized expertise is provided in an interdisciplinary format lead by physician medical directors. Amputation rehabilitation coordinators assure coordination of services and provider communication both across the continuum of care and across facilities. These factors, along with specialized education and training, have enhanced the environment of care and created greater consistency in the delivery of rehabilitation services for Veterans with amputations. Achieving these goals provides the VA the opportunity to fulfill its vision to be a world leader in providing lifelong amputation care. The ASoC operates in close collaboration with the Department of Defense (DOD) amputation care programs. While the VA system of care has many features similar to the DOD amputation care programs, it also differs in several ways. Both the VA and DOD amputation care programs use a team approach to care and focus on individual treatment goals, can provide any prosthetic device that is commercially available, and are involved in collaborative research involving new prosthetic technology and treatment advances. The two systems differ in that the DOD specialized amputation care is focused primarily at three Advanced Rehabilitation Centers, whereas the VA system is more diffuse, using a tiered approach with services spread across 133 medical facilities. The DOD amputation care programs are focused primarily on providing initial prosthetic fitting and acute rehabilitation, whereas the VA system places a greater emphasis on lifelong care and care management. …