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Assessing Therapeutic Angiogenesis in a Murine Model of Hindlimb Ischemia
Published on: June 8, 2019
Development and Description of a National Cohort of Patients With Chronic Limb-Threatening Ischemia
Alexander C Fanaroff1,2,3,4, Elias J Dayoub1,2,3, Lin Yang2,3
1Cardiovascular Medicine Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Insights
This study created the Chronic Limb-threatening Ischemia Process PERformace (CLIPPER) cohort using Medicare data to develop quality measures for CLTI care. The cohort will help address disparities in treatment and outcomes for this serious condition.
Area of Science:
- Vascular Surgery
- Health Services Research
- Epidemiology
Background:
- Chronic limb-threatening ischemia (CLTI) is a severe condition associated with high morbidity and mortality.
- Significant disparities in CLTI outcomes exist across racial, ethnic, socioeconomic, and geographic groups.
- There is a lack of established process measures to assess the quality of CLTI care.
Purpose of the Study:
- To develop and validate quality measures for CLTI care.
- To create a large cohort of CLTI patients using administrative claims data.
- To investigate disparities in CLTI care and outcomes.
Main Methods:
- Utilized fee-for-service Medicare inpatient and outpatient claims data from 2010-2019.
- Developed a coding algorithm to identify patients with CLTI based on diagnostic and procedural codes.
- Defined inclusion criteria including peripheral artery disease codes with ulceration/infection/gangrene or CLTI-specific codes, plus arterial vascular testing.
Main Results:
- The Chronic Limb-threatening Ischemia Process PERformace (CLIPPER) cohort includes 1,130,065 CLTI patients.
- Mean age was 75 years, 48.4% were women, and 14.6% were Black.
- Within 30 days of diagnosis, 20.4% received revascularization; within 1 year, 16.7% died.
Conclusions:
- The CLIPPER cohort, derived from Medicare claims, provides a valuable resource for CLTI research.
- This cohort will enable the development of process measures for CLTI care quality.
- Future research will examine the association of these measures with limb outcomes and health disparities.
Background:
Chronic limb-threatening ischemia (CLTI) is a common condition with high rates of morbidity and mortality. Despite extensive literature documenting poor outcomes in patients with CLTI, as well as racial, ethnic, socioeconomic, and geographic disparities in these outcomes, process measures for high-quality CLTI care have not been developed. We developed the Chronic Limb threatening Ischemia Process PERformace (CLIPPER) cohort to develop and test the validity of CLTI care quality measures.
Methods:
Using inpatient and outpatient claims data from patients with fee-for-service Medicare from 2010 to 2019, we created a coding algorithm to identify patients with CLTI. To qualify for a CLTI diagnosis, patients had to have either diagnostic codes for peripheral artery disease and for ulceration, infection, or gangrene on the same inpatient or outpatient claim or a CLTI-specific diagnostic code. Patients were also required to have a procedural code indicating arterial vascular testing within 6 months before or after the earliest qualifying CLTI diagnostic code(s). We describe baseline characteristics and long-term outcomes of this cohort.
Results:
The final cohort comprised 1,130,065 patients diagnosed with CLTI between 2010 and 2019. Mean (±SD) age of the cohort was 75 ± 5.8 years; 48.4% were women, and 14.6% were Black. Within 30 days of CLTI diagnosis, 20.4% of patients underwent either percutaneous or surgical revascularization. Within 6 months, 3.3% of patients underwent major amputation; 16.7% of patients died within 1 year and 50.3% within 5 years.
Conclusions:
We described the development of a cohort of fee-for-service Medicare patients with CLTI using inpatient and outpatient Medicare claims data. CLIPPER will be a resource for developing a set of process measures that can be captured from administrative claims data, with plans to describe their association with limb outcomes and corresponding racial, ethnic, socioeconomic, sex-based, and geographic variability.
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