{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T01:58:51Z","timestamp":1789869531905,"version":"4.0.1"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2011,4,14]],"date-time":"2011-04-14T00:00:00Z","timestamp":1302739200000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2011,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the factors affecting postacute care discharge decisions among persons undergoing major lower limb amputations as a result of dysvascular causes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A population\u2010based, multicenter prospective study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Eighteen participating hospitals in Baltimore, Maryland, and Milwaukee, Wisconsin, served as the referral base for this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>The study population consisted of patients aged 21 years or older who underwent a major (foot or higher level) lower limb amputation as a result of dysvascular causes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients were identified and recruited during their acute hospital admission at one of the participating hospitals. Data were drawn from (1) acute care medical chart reviews; (2) surveys administered shortly after patients underwent amputation, while they were receiving acute care, that assessed their function the month before amputation and other demographic and social information; and (3) a 6\u2010month follow\u2010up telephone interview.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>The outcome of interest was the postacute discharge setting in which the initial rehabilitation services, if any, were delivered to the patient during the reference period of 6 months after index amputation surgery. Discharge to alternative postacute settings\u2014inpatient rehabilitation facility (IRF), skilled nursing facility (SNF, reference category), and home\u2014were contrasted with use of <jats:italic>t<\/jats:italic>\u2010 and \u03c7<jats:sup>2<\/jats:sup> test statistics. A 3\u2010category, multinominal logit model was used to examine the independent effects of sociodemographic, geographic, health, and amputation\u2010related characteristics on the likelihood of discharge to alternative settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 348 patients consented to participate in the study, with an overall participation rate of 87.1%. One hundred ninety\u2010two patients (55.2%) were discharged to an IRF, 73 (21%) were discharged to an SNF, and 83 (23.8%) were discharged directly home. The mean age of the sample was 63.7 years; the majority (59.2%) were men, and more than one quarter African Americans. More than half of those reporting were poor (income &lt;$15,000\/year). On average, patients had 5 co\u2010morbidities, and nearly half had an amputation at the below\u2010knee level. Discharge to an IRF (versus an SNF) was more likely in patients who were married, had greater cognitive functioning, had unilateral below\u2010knee amputations, had Medicaid coverage, and were living in Milwaukee, Wisconsin. Patients were less likely to be discharged home (versus to an SNF) if they were older, unmarried, had a previous history of nursing home residence, and had more perioperative complications. Discharge destination was not affected by gender or race.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Postacute care decisions largely appear to be made on the basis of medical and family support factors. The findings of this research provide a necessary first step in the challenging task of assessing and quantitatively modeling the long\u2010term functional outcomes of persons who receive postacute care in alternative settings by allowing more optimal case mix adjustment for factors that simultaneously influence rehabilitation setting and outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.pmrj.2010.12.019","type":"journal-article","created":{"date-parts":[[2011,4,20]],"date-time":"2011-04-20T16:09:49Z","timestamp":1303315789000},"page":"336-344","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Determinants of Postacute Care Discharge Destination After Dysvascular Lower Limb Amputation"],"prefix":"10.1002","volume":"3","author":[{"given":"Timothy R.","family":"Dillingham","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer N.","family":"Yacub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana E.","family":"Pezzin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2011,4,14]]},"reference":[{"key":"e_1_2_6_2_2","first-page":"875","article-title":"Limb amputation and limb deficiency: Epidemiology and recent trends in the United States","volume":"95","author":"Dillingham T.R.","year":"2002","journal-title":"South Med J"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2002.34805"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2001.21856"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004356-199103000-00006"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.19.1.48"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-199906000-00008"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.16.1.349"},{"key":"e_1_2_6_9_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3109\/03093648809079386","article-title":"Lower limb amputations in southern Finland 1984\u20101985","volume":"12","author":"Pohjolainen T.","year":"1988","journal-title":"Prosthet Orthot Int"},{"key":"e_1_2_6_10_2","doi-asserted-by":"crossref","first-page":"88","DOI":"10.3109\/03093649909071618","article-title":"Epidemiology of lower limb amputees in southern Finland in 1995 and trends since 1984","volume":"23","author":"Pohjolainen T.","year":"1999","journal-title":"Prosthet Orthot Int"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.89.8.1222"},{"key":"e_1_2_6_12_2","doi-asserted-by":"crossref","first-page":"124","DOI":"10.3109\/03093649209164324","article-title":"Rehabilitation after amputation for vascular disease: A follow\u2010up study","volume":"16","author":"De Luccia N.","year":"1992","journal-title":"Prosthet Orthot Int"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.3109\/03093649309164349"},{"key":"e_1_2_6_14_2","first-page":"561","article-title":"Limb loss in association with vascular surgery\u2014a five\u2010year series of major lower\u2010limb amputation","volume":"160","author":"Wahlberg E.","year":"1994","journal-title":"Eur J Surg"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(00)90074-1"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.21.3.C11"},{"key":"e_1_2_6_17_2","doi-asserted-by":"crossref","first-page":"25","DOI":"10.3109\/03093648709079376","article-title":"Evaluation of introducing the team approach to the care of the amputee: The Dulwich study","volume":"11","author":"Ham R.","year":"1987","journal-title":"Prosthet Orthot Int"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800640411"},{"key":"e_1_2_6_19_2","first-page":"67","article-title":"What influence does age have on rehabilitation of amputees?","volume":"30","author":"Kerstein M.D.","year":"1975","journal-title":"Geriatrics"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-3956(75)90026-6"},{"key":"e_1_2_6_21_2","volume-title":"The MOS 36\u2010Item Short Form Health Survey: Manual and Interpretation Guide","author":"Ware J.","year":"1993"},{"key":"e_1_2_6_22_2","first-page":"1337","article-title":"Who is the marginal patient? 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