Frequency of Care and Mortality Following an Incident Diagnosis of Peripheral Artery Disease in the Inpatient or Outpatient Setting: The ARIC (Atherosclerosis Risk in Communities) Study
Frequency of Care and Mortality Following an Incident Diagnosis of Peripheral Artery Disease in the Inpatient or Outpatient Setting: The ARIC (Atherosclerosis Risk in Communities) Study
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DOI：
10.1161/jaha.117.007332
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发表时间：
2018-04-17
影响因子：
5.4
通讯作者：
Kucharska-Newton, Anna
中科院分区：
文献类型：
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作者：
Kalbaugh, Corey A.;Loehr, Laura;Kucharska-Newton, Anna
背景 - 外周动脉疾病 (PAD) 患者的可用健康服务数据通常来自对符合资格或正在接受干预的患者的研究。按环境（门诊患者与住院患者）对初始 PAD 诊断后的护理频率和死亡率的了解是有限的，这代表了提供新基准信息的机会。方法和结果 - 本研究的目的是使用与医疗保险和医疗补助服务中心相关的 ARIC（社区动脉粥样硬化风险）研究队列的数据来描述门诊或住院环境中 PAD 事件诊断后的护理频率和死亡率 按服务收费的索赔数据（2002-2012 年）。使用直接标准化来估计年龄标准化的遭遇率和死亡率。 PAD 由任何索赔位置的帐单代码定义。我们观察了 1086 例 PAD 病例（873 例门诊患者，213 例住院患者）。诊断后 1 年，在门诊诊断的参与者每人每年有 2.15 次（95% 置信区间 [CI]，2.10-2.21）与 PAD 相关的门诊就诊，6.4%（95% CI，4.8-8.1）有与 PAD 相关的住院治疗。相反，在住院环境中诊断的参与者每人年有 1.02（95% CI，0.94-1.10）例与 PAD 相关的门诊就诊，14.2%（95% CI，9.3-18.7）有与 PAD 相关的再住院。在门诊和住院患者中诊断的患者的一年死亡率分别为 7.1% (95% CI, 5.4-8.7) 和 16.0% (95% CI, 11.0-21.1)。 结论 - 这项研究提供了通过初始 PAD 诊断来估计护理频率和死亡率的重要数据。患有 PAD 的人经常接受医疗保健，而在住院环境中诊断出来的患者再住院率和死亡率很高。
Background-Available health services data for individuals with peripheral artery disease (PAD) are often from studies of those eligible for or undergoing intervention. Knowledge of the frequency of care and mortality following an initial PAD diagnosis by setting (outpatient versus inpatient) is limited and represents an opportunity to provide new benchmark information.Methods and Results-The purpose of this study was to characterize the frequency of care and mortality following an incident PAD diagnosis in the outpatient or inpatient setting using data from the ARIC (Atherosclerosis Risk in Communities) study cohort linked with Centers for Medicare and Medicaid Services fee-for-service claims data (2002-2012). Direct standardization was used to estimate age-standardized rates of encounters and mortality. PAD was defined by billing code in any claim position. We observed 1086 incident PAD cases (873 outpatient, 213 inpatient). At 1 year after diagnosis, participants diagnosed in the outpatient setting had 2.15 (95% confidence interval [CI], 2.10-2.21) PAD-related outpatient encounters per person-year, and 6.4% (95% CI, 4.8-8.1) had a PAD-related hospitalization. Conversely, participants diagnosed in the inpatient setting had 1.02 (95% CI, 0.94-1.10) PAD-related outpatient encounters per person-year, and 14.2% (95% CI, 9.3-18.7) had a PAD-related rehospitalization. One-year mortality was 7.1% (95% CI, 5.4-8.7) and 16.0% (95% CI, 11.0-21.1) among those diagnosed in outpatient and inpatient settings, respectively.Conclusions-This study provides important data estimating frequency of care and mortality by the setting of initial PAD diagnosis. Individuals with PAD are frequent users of health care, and those diagnosed in the inpatient setting have high rates of rehospitalization and mortality.