Quality of Medical Care Provided to Service Members with Combat-Related Limb Amputations: Report of Patient Satisfaction

Article excerpt


The advancement of medical knowledge, especially rehabilitation services, historically has been associated with times of war [1-3]. The disciplines of physiatry, physical and occupational therapy, rehabilitation engineering, and vocational rehabilitation were largely formed in response to the needs of injured soldiers returning from the first and second World Wars [2-5]. Technological advances in assistive devices, such as wheelchairs, prostheses, and orthoses, were largely discovered to improve the lives of veterans with paralysis and limb loss [4-6]. Further, the determination of many veterans with disabilities to return to highly active lifestyles has greatly contributed to improved access of all individuals with disabilities to sports and recreation [7-8].

Since the United States began its efforts in the global war on terrorism (GWOT) in 2001, 737 military service members as of January 1, 2008 have sustained major limb amputations associated with military operations in Iraq and Afghanistan [9]. Most (n = 540, 73.3%) of these service members have been treated in Washington, DC, at Walter Reed Army Medical Center (WRAMC), a healthcare center that offers a highly structured and interdisciplinary program of care for individuals with amputations. Providers from multiple services, such as surgical, medical, and rehabilitation specialties, are integrated with psychosocial support groups, vocational counselors, peer visitors, recreational and sports groups, and various other public and private organizations to deliver the highest quality of care. The remaining service members were treated at Brooke Army Medical Center in San Antonio, Texas, and at the Naval Medical Center San Diego in San Diego, California. The study reported in this article was conducted solely at WRAMC.

Patient satisfaction is one of the most vital quality outcome measures in the assessment of the performance of healthcare systems and personnel [10]. Previously used as a management tool by the Department of Defense (DOD), satisfaction surveys assess patient satisfaction with the healthcare services provided [11-12]. Similarly, the WRAMC Amputee Clinic has established multiple methods of evaluation and feedback to improve and maintain the excellence of its services. Quality outcomes have been established for several domains of medical, surgical, and rehabilitative care and, in particular, the peer component of all aspects of recovery. To ensure quality of inpatient care and promote performance improvement, the staff of the Physical Medicine and Rehabilitation Service at WRAMC created a Quality of Care (QoC) Questionnaire to administer to service members during their initial outpatient visits to the WRAMC Amputee Clinic. This survey contained 23 questions on key aspects of medical and rehabilitative care (i.e., psychological support, pain management, medical care, education, and accommodations); each question was rated on a 10-point Likert scale [13]. Questions focus on the period of time from the service member's initial injury to his or her discharge from inpatient services at WRAMC.

This study analyzed satisfaction ratings on the various aspects of medical and rehabilitative care provided to military service members who sustained limb amputations during military operations in the GWOT. In particular, the survey investigated the importance of support and peer groups in the treatment of patients with amputations. While the Department of Veterans Affairs (VA)/DOD practice guidelines for rehabilitation suggest use of peer support groups as a rehabilitation method, other studies make stronger claims about the import of such peer groups.* One study that investigated the importance of peer visitation found the visitations to have even greater impact than education [14], while others researchers indicated that peer groups enabled patients to better cope with depression, fear, and helplessness [15-16]. …


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