Clinician Specialty, Access to Care, and Outcomes Among Patients with Peripheral Artery Disease.
Clinician Specialty, Access to Care, and Outcomes Among Patients with Peripheral Artery Disease.
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DOI：
10.1016/j.amjmed.2021.08.025
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Jones WS
中科院分区：
文献类型：
--
作者：
Weissler EH;Ford CB;Narcisse DI;Lippmann SJ;Smerek MM;Greiner MA;Hardy NC;O'Brien B;Sullivan RC;Brock AJ;Long C;Curtis LH;Patel MR;Jones WS
了解外周动脉疾病模式和结果之间的关系是改善护理和结果的重要一步。我们假设临床医生的专业与主要不良血管事件（MAVE）的发生相关。根据临床医生（心脏病专家、外科医生、足科医生、初级保健医生或其他）的专业，将在我们的卫生系统和按服务收费的医疗保险中至少有1次外周动脉疾病相关就诊的患者分组，这些临床医生在索引就诊前一年提供了多种外周动脉疾病编码的护理。主要结局为MAVE（全因死亡率、心肌梗死、卒中、下肢血运重建和下肢截肢的复合终点）。该队列包括1，768名患者，其中30.0%是黑人，23.9%符合医疗补助双重入学资格，31.1%生活在农村地区。接受足科医生多种护理的患者1年MAVE（34.4%，p<.001）、住院（65.9%，p<.001）和截肢（22.6%，p<.001）率最高。调整后，临床医生专业与结局无关。符合医疗补助双重资格的患者有较高的调整后死亡风险（HRadj 1.54，95%CI 1.11-2.14）和全因住院风险（HRadj 1.20，95%CI 1.03-1.40），黑人患者有较高的调整后截肢风险（HRadj 1.49，95%CI 1.03-2.15）。临床专业与调整后的不良结局无关，但某些社会经济因素与调整后的不良结局相关。临床医生专业和社会经济地位的影响可能因本研究中所有患者都有健康保险而减弱;这些分析需要在更具代表性的队列中进行确认。
Understanding the relationship between patterns of peripheral artery disease patterns and outcomes is an essential step towards improving care and outcomes. We hypothesized that clinician specialty would be associated with occurrence of major adverse vascular events (MAVE). Patients with at least 1 peripheral artery disease-related encounter in our health system and fee-for-service Medicare were divided into groups based on the specialty of the clinician (cardiologist, surgeon, podiatrist, primary care, or other) providing a plurality of peripheral artery disease-coded care in the year prior to index encounter. The primary outcome was MAVE (a composite of all-cause mortality, myocardial infarction, stroke, lower extremity revascularization, and lower extremity amputation). The cohort included 1,768 patients, of whom 30.0% were Black, 23.9% were Medicaid dual-enrollment eligible, and 31.1% lived in rural areas. Patients receiving a plurality of their care from podiatrists had the highest 1-year rates of MAVE (34.4%, p<.001), hospitalization (65.9%, p<.001), and amputations (22.6%, p<.001). Clinician specialty was not associated with outcomes after adjustment. Patients who were Medicaid dual-eligible had higher adjusted risks of mortality (HRadj 1.54, 95%CI 1.11–2.14) and all-cause hospitalization (HRadj 1.20, 95%CI 1.03–1.40) and patients who were Black had a higher adjusted risk of amputation (HRadj 1.49, 95%CI 1.03–2.15). Clinician specialty was not associated with worse outcomes after adjustment, but certain socioeconomic factors were. The effects of clinician specialty and socioeconomic status were likely attenuated by the fact that all patients in this study had health insurance; these analyses require confirmation in a more representative cohort.
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