Relationship between regional spending on vascular care and amputation rate
Philip P Goodney1, Lori L Travis2, Benjamin S Brooke3
1Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire2Dartmouth-Hitchcock Medical Center, Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
JAMA Surgery
|November 22, 2013
Summary
Higher spending on vascular care did not correlate with lower amputation rates in peripheral arterial disease patients. Regions with more spending performed more procedures, particularly endovascular interventions, but amputation rates remained unchanged, suggesting cost-saving opportunities.
Area of Science:
- Vascular Surgery
- Health Economics
- Public Health
Background:
- Lower extremity revascularization is crucial for preventing amputation in patients with severe peripheral arterial disease (PAD).
- The association between regional healthcare expenditure on vascular services and PAD-related amputation rates is not well-established.
- Understanding this relationship is vital for optimizing resource allocation and patient outcomes.
Purpose of the Study:
- To investigate the hypothesis that increased regional spending on vascular care correlates with decreased amputation rates among patients with severe PAD.
- To analyze the relationship between Medicare spending on vascular procedures and amputation incidence across US hospital referral regions.
Main Methods:
- A retrospective cohort study involving 18,463 US Medicare beneficiaries who underwent major lower extremity amputations due to PAD between 2003 and 2010.
- Analysis of price-adjusted Medicare spending on revascularization and related vascular care in the year preceding amputation.
- Calculation of the correlation between regional spending and regional amputation rates.
Main Results:
- Significant variation in per-patient spending on vascular care was observed, ranging from $11,077 to $42,613.
- Regions with higher spending exhibited higher rates of vascular procedures, including endovascular interventions (OR 3.5 in highest quintile vs. lowest).
- Despite increased spending and procedure volume, higher regional spending did not show a significant association with lower amputation rates (R=0.10, P=0.06).
Conclusions:
- Regions allocating more resources to vascular care perform more procedures, particularly endovascular interventions, prior to amputation.
- Current evidence does not support a link between increased regional vascular care spending and reduced amputation rates.
- This suggests potential for cost containment in vascular services without negatively impacting amputation rates, highlighting an area for quality improvement and efficiency gains.
More Related Videos
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
2.8K
08:16High-Resolution Three-Dimensional Imaging of the Footpad Vasculature in a Murine Hindlimb Gangrene Model
Published on: March 16, 2022
3.1K
Related Concept Videos
01:12Regional Terms
17.5K
Regional terms describe anatomy by dividing the body parts into different regions that contain structures involved in contributing similar functions. Using these terms helps increase the accurate description and identification of the particular region of interest or region affected by the disease.
Primarily, the human body has two major regions, the axial and appendicular regions. The axial region comprises regions from the head to the abdomen and makes up the central body axis. In contrast,...
Primarily, the human body has two major regions, the axial and appendicular regions. The axial region comprises regions from the head to the abdomen and makes up the central body axis. In contrast,...
17.5K
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
2.2K
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
2.2K
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
773
Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
773
01:27Peripheral Artery Disease III: Interprofessional Care
659
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
659
01:23Peripheral Artery Disease V: Postoperative Nursing Management
637
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
637
01:26Varicose Veins II: Diagnostic Studies and Interprofessional Care
325
Varicose veins, or varicosities, develop when the valves in the veins, which control blood flow, weaken or damage. It causes blood to pool and the veins to enlarge. Understanding the clinical manifestations, diagnostic approaches, and management options for varicose veins is crucial for effective treatment and relief.Clinical manifestationsClinical manifestations of varicose veins include a heavy, achy feeling or pain after prolonged standing or sitting. This discomfort can often be relieved by...
325