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Using Additive Manufacturing to Reimagine Orthotics and Prosthetics Care Within VHA

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Conference Abstract: The Veteran’s Health Administration (VHA) is the largest interconnected hospital system in the United States, serving approximately 9 million Veterans. Due to the size of its patient population, the VHA has a unique opportunity to develop and deploy clinical innovations at scale. The VHA operates more than 80 accredited orthotics and prosthetics (O&P) facilities and covers the full cost of O&P devices for eligible Veteran patients, whether the care is provided by the VHA or the community.

Approximately one in four Veteran patients suffers from diabetes, increasing their risk of foot ulceration (skin breakdown) which can lead to amputation . The number of Veteran patients living with an amputation is increasing at a rate of about 50% per year, yet many will not wear their prosthesis due to discomfort. The average annual cost of treating a single diabetic foot ulcer has been estimated at $14,000 and the three-year survival rate following amputation is only 59%. Estimated lifetime prosthetic costs for an individual with unilateral lower limb amputation could range from $0.5 to $1.8 million. The goal of accommodative orthotics is to reduce the risk of amputation due to diabetic ulcers while the goal of the prosthetic care is to improve the amputee’s quality of life.

However, there is considerable variability in O&P devices and therefore an opportunity to standardize their fabrication and evaluation. The VHA is addressing these challenges by developing a digital workflow, 3D-printed diabetic insoles, and 3D-printed definitive transtibial sockets. However, a reimagining of VHA digital and manufacturing infrastructure is required to adopt these technologies.

To accelerate O&P care for Veteran patients, there is an innovation opportunity to improve standardization through novel 3D printing materials and processes which are tailored to needs of VHA.