Overuse of early peripheral vascular interventions for claudication

Area of Science:

• Vascular Surgery
• Health Services Research
• Medical Economics

Background:

• Guidelines recommend limiting peripheral vascular interventions (PVIs) for claudication to patients with severe symptoms after conservative therapy.
• Practice patterns regarding early PVI after new claudication diagnosis require evaluation for guideline adherence.

Purpose of the Study:

• To explore practice patterns and physician characteristics associated with early PVI in newly diagnosed claudication patients.
• To assess adherence to Society for Vascular Surgery and Choosing Wisely guidelines.

Main Methods:

• Analysis of Medicare fee-for-service claims for first-time claudication diagnoses (2015-2017).
• Definition of early PVI as intervention within 6 months of diagnosis.
• Physician-level PVI utilization rates calculated and analyzed using hierarchical multivariable logistic regression.

Main Results:

• 3.2% of 194,974 patients underwent early PVI; median physician rate was 0% (range 0-58.3%).
• Higher early PVI utilization associated with services in ambulatory surgery centers/offices, male physician sex, fewer years in practice, rural location, and lower claudication patient volume.
• 320 physicians (5.6%) had early PVI rates ≥14%, indicating outlier practice patterns.

Conclusions:

• Outlier physicians with high early PVI rates for claudication are identifiable via claims data.
• Confidential data-sharing programs and educational guidance can address high utilization and promote guideline adherence.