Philip P. Goodney, Benjamin S. Brooke, Randall R. De Martino, Kristina A. Giles, David H. Stone, Brian Nolan, Jack L. Cronenwett
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
OBJECTIVES: Differences in access to vascular care remain unexplained for patients with lower extremity PAD. We studied relationships between the quality of medical care for patients with PAD and access to vascular care.
METHODS: We identified a cohort of 52,505 Medicare patients with pre-existing diabetes, PAD and foot ulceration who required hospitalization for foot cellulitis. Across regions in the Dartmouth Atlas, we determined the proportion of patients that received appropriate, high-quality medical care, defined as 1) hemoglobin A1C testing, 2) podiatric care, and 3) non-invasive vascular testing, all within 1 year of hospital admission. We assessed regional relationships between quality of medical care and vascular care, defined as diagnostic/therapeutic vascular care for CLI patients.
RESULTS: Across the United States, only 36% of diabetic patients with PAD and tissue loss received all 3 components of high quality medical care; 76% received 2 of 3 components. A non-invasive vascular study was absent in 41%. Provision of high-quality medical care varied across regions, from 4% of patients in Mason City, Iowa, to 58% of patients in Sun City, Arizona. Regions most likely to provide high-quality medical care were 24% more likely to provide invasive vascular care (p<0.001, Figure 1).
CONCLUSIONS: Fewer than 4 out of 10 Medicare diabetics with PAD and tissue loss receive appropriate, high-quality medical care. Quality improvement efforts at limiting amputation must involve primary care providers, as high-quality medical care is an important determinant of access to vascular care.
AUTHOR DISCLOSURES: B. S. Brooke:
Nothing to disclose; J. L. Cronenwett:
Nothing to disclose; R. R. De Martino:
Nothing to disclose; K. A. Giles:
Nothing to disclose; P. P. Goodney:
Nothing to disclose; B. Nolan:
Nothing to disclose; D. H. Stone:
Nothing to disclose.
Posted April 2013