Screening for peripheral arterial disease in a rural community health setting

Peripheral arterial disease (PAD) is a slow, progressive disease associated with systemic atherosclerosis. It is common in older adults and often underdiagnosed and undertreated. Primary care providers play a key role in the early detection and treatment of PAD by screening patients in clinic who are symptomatic or at risk for PAD. We implemented a quality improvement project in a rural community health clinic to determine the accuracy of an ankle brachial index (ABI) in a clinic setting compared with ABI done in a hospital vascular laboratory before and after additional skills training for the primary care provider. The cost of an ABI screen in the hospital is considerably more than the screen done in a clinic setting. Improving accuracy in the performance of an ABI screen in a rural clinic to match that done in a hospital laboratory would be a considerable cost-saving initiative. This project demonstrated that additional provider training, clinical experience, and modification of the procedure resulted in increased accuracy of clinic ABIs when matched with the local hospital vascular laboratory screen.