IMPACT 2: The Role of Earlier Receipt of a Lower Limb Prosthesis on Emergency Department Utilization


PM&R Journal
Read Online


Taavy A Miller, MSPO1,2, Rajib Paul1, PhD, Melinda Forthofer, PhD1, Shane R. Wurdeman, PhD2,3

  1. Department of Public Health, University of North Carolina at Charlotte, Charlotte, NC, USA
  2. Department of Clinical and Scientific Affairs, Hanger Clinic, Austin, TX, USA
  3. Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE, USA


In order to quantify the impact on healthcare utilization, emergency department utilization was applied as a proxy for overall healthcare utilization. Two separate models were implemented to determine associations to utilization. The first model evaluated the effect of timing of prosthesis receipt on utilization. The second model assessed the impact adverse events (i.e. falls or fractures) had on utilization within this unique population.


To determine the role timing of prosthesis receipt has in emergency department (ED) utilization and the association of fall/fall-related injury with healthcare utilization.


Data on adults with lower limb amputation (n=510) were obtained from a nationally representative administrative claims database (Watson). All individuals were continually enrolled on a commercial insurance plan for the entirety of the period from 2014-2016.

About Watson: The Watson database is a large US private sector health claims database containing de-identified records representing approximately 25% of all commercial claims aggregated into one database with patient-level enrollment history, medical, and pharmacy commercials claims nationwide.

Patient Inclusion Criteria:

Patient Demographics:

Table 1: Sample demographic characteristics and inferential statistics stratified by receipt of prosthesis.


Figure 2: Comparison of percent of emergency department (ED) use that changes based on timing of prosthesis receipt proportional to group size

Figure 3: Predicted probability of ED use versus age stratified by time to prosthesis receipt


Authors from Hanger Clinic

Shane Wurdeman, PhD, CP, FAAOP (D)

Director, Clinical Research, Hanger Clinic

Dr. Wurdeman has published numerous studies in peer-reviewed journals. In addition to his research work, he continues to manage a patient case load with Hanger Clinic.

View Full Bio >

Taavy A. Miller, PhD, CPO

Research Scientist

After earning her MSPO and working as a CPO, Taavy taught O&P and then earned her PhD in health services research. She has published several studies in peer-reviewed journals, presented abstracts at various conferences, and currently works as a research scientist conducting and leading research projects with a focus on patient outcomes. 

Latest Updates

Subscribe to stay up-to-date on our latest posts.

View All