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Volume 41 Number 4, July/August 2004
Pages xi — xii

Guest Editorial

Recent QUERI workshop analyzes optimum treatment for combat amputees

At Walter Reed Army Medical Center (WRAMC), a new generation of war-wounded soldiers is arriving with major limb amputation from the wars in Iraq and Afghanistan. More than 144 amputees from the Operations Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) are being treated at WRAMC and the number is growing. The mission of the Department of Veterans Affairs (VA) and the Department of Defense (DoD) is to ensure that our newest veterans receive superior care so that they may return to living healthy and productive lives as quickly as possible, as well as maintain that quality of care throughout their lifetimes.

The VA's healthcare system is like no other, with 163 medical centers, 800 clinics, and an electronic filing system containing more than 1,300 points of care. Patient care resources are driven by best practices, not insurance company constraints. On May 19-20, 2004, health researchers, clinician scientists, and rehabilitation specialists from WRAMC and the VA met at the VA's Office of Research and Development in Washington, DC for a traumatic amputation QUERI (Quality Enhancement Research Initiative) workshop.

The goal of this workshop was to teach WRAMC and VA personnel the QUERI process and to educate existing QUERI center personnel about questions in traumatic amputee healthcare that beg investigation. The workshop focused on using the QUERI process to document best practices, develop strategies for implementation, and disseminate results and recommendations in amputee healthcare. The QUERI workshop is only one example of the joint efforts by the VA and WRAMC to work together in caring for our returning service men and women, with the mutual goal of restoring them to the highest viable level of independence and functioning.

Developed by VA's Health Service Research and Development Service in 1998, QUERI is a comprehensive, outcomes-based, quality improvement program that is data driven, utilizing a process that facilitates the implementation of research findings into evidence-based clinical practices. QUERI is a process that focuses on the development of a strategic plan of research and quality improvement procedures to implement best care within Veteran's Health Administration (VHA). QUERI documents clinical activities and identifies those old and new procedures that promote best outcomes. The QUERI process is also designed to correct any performance gaps. This requires a coordinated effort on the part of healthcare providers, clinician scientists, and VA administrators. To date, QUERI has been able to initiate improvements in care in a number of chronic disease states, including depression, diabetes, ischemic heart disease, and substance abuse. This is the first time the model is being applied to a deployment-related condition.

The first day of the two-day workshop included presentations on current standards of amputee care, ongoing research, and the existing gaps between the two. After these presentations, participants were divided into working groups to focus more closely on specific amputee healthcare issues. The topics discussed included access to amputee healthcare resources in the VA, prosthetic prescriptions (who needs what), prosthetic fitting, postprosthetic rehabilitation, comorbidities associated with traumatic amputation, and psychosocial issues unique to amputees. Working group members also met with various health services research experts in each of the six steps of QUERI. Participants learned more about amputee healthcare and what QUERI could do to improve clinical care throughout VA by outlining a complete six-step QUERI process in their topic area.

For those interested in details of the QUERI translational research model, go to Complete presentations on the Traumatic Amputation QUERI Workshop can also be found at

Danielle M. Kerkovich, PhD
Office of Research and Development, Department of Veterans Affairs

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