Conceptualization of a public limb-loss/amputee database: Applying framework concepts from the Veterans Administration National Prosthetics Patient Database

Abstract

Current trends in the United States are leading to a significant incidence and prevalence of persons afflicted with limb loss (amputation) and subsequent dependence on artificial limbs/prosthetics. Two primary factors are contributing to this increase: diabetic infection resulting in limb amputation, and current military/war events and practices.

No comprehensive or integrated database exists on the national or state level that reflects amputee care within the civilian population, although limb loss/deficiency statistics are available to the public through the Amputee Coalition of America (ACA), their partners, and the Centers for Disease Control and Prevention (CDC). Nonetheless, the Veteran Affairs Health Care System ( a public health system at work) has created the National Prosthetic Patient Database (NPPD) that goes far to address this issue. The NPPD is the product of the Prosthetics Software Package with which every Prosthetics-Orthotics Service in the VA system transmits data to a centralized database (the NPPD) regarding prosthetic costs, patient visit information and the prosthetic vendor. When analyzed in conjunction with the VA's National Patient Care Database (NPCD), powerful information may be derived regarding prosthetic prescriptions, patient care trends and marketing influences. However, combining the two databases is cumbersome and time-consuming, as well as not easily accessible. Little published research exists that takes advantage of this source for amputee health care trends. Further, although the NPPD/NPCD is clearly a system reflective of national geographic and VA Health Care System trends, the uniqueness of its study population (Veterans) and their access to free or low cost prosthetics and health care is less reflective of the US civilian amputee population at large.

Given pending and current trends in health care reform, a more comprehensive and accessible amputee national database is proposed, based on the NPPD/NPCD framework, and structured around Hospital Discharge Records, Prosthetists-Orthotists' licensing boards and Medicare/Medicaid billing transactions. Toward this end, the conceptualization of a Texas Amputee-Prosthetic Database (TAPD) is presented, which is based on the framework of the Veteran Affairs NPPD, and utilizes pre-existing Texas Department of State Health Services database fields and practices. The advantages, disadvantages, limitations and potentials of a TAPD will be discussed, as well as a brief overview of current amputee care trends.