Author + information
- Received November 28, 2016
- Revision received March 13, 2017
- Accepted March 23, 2017
- Published online June 5, 2017.
- Ryan S. Turley, MDa,
- Xiaojuan Mi, PhDb,
- Laura G. Qualls, MSb,c,
- Sreekanth Vemulapalli, MDb,c,
- Eric D. Peterson, MD, MPHb,c,
- Manesh R. Patel, MDb,c,
- Lesley H. Curtis, PhDb,c and
- W. Schuyler Jones, MDb,c,∗ ()
- aDepartment of Surgery, Duke University School of Medicine, Durham, North Carolina
- bDuke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- cDepartment of Medicine, Duke University School of Medicine, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. W. Schuyler Jones, Duke University Medical Center, Box 3330, Durham, North Carolina 27710.
Objectives Modifications in reimbursement rates by Medicare in 2008 have led to peripheral vascular interventions (PVI) being performed more commonly in outpatient and office-based clinics. The objective of this study was to determine the effects of this shift in clinical care setting on clinical outcomes after PVI.
Background Modifications in reimbursement have led to peripheral vascular intervention (PVI) being more commonly performed in outpatient hospital settings and office-based clinics.
Methods Using a 100% national sample of Medicare beneficiaries from 2010 to 2012, we examined 30-day and 1-year rates of all-cause mortality, major lower extremity amputation, repeat revascularization, and all-cause hospitalization by clinical care location of index PVI.
Results A total of 218,858 Medicare beneficiaries underwent an index PVI between 2010 and 2012. Index PVIs performed in inpatient settings were associated with higher 1-year rates of all-cause mortality (23.6% vs. 10.4% and 11.7%; p < 0.001), major lower extremity amputation (10.1% vs. 3.7% and 3.5%; p < 0.001), and all-cause repeat hospitalization (63.3% vs. 48.5% and 48.0%; p < 0.001), but lower rates of repeat revascularization (25.1% vs. 26.9% vs. 38.6%; p < 0.001) when compared with outpatient hospital settings and office-based clinics, respectively. After adjustment for potential confounders, patients treated in office-based clinics remained more likely than patients in inpatient hospital settings to require repeat revascularization within 1 year across all specialties. There was also a statistically significant interaction effect between location of index revascularization and geographic region on the occurrence of all-cause hospitalization, repeat revascularization, and lower extremity amputation.
Conclusions Index PVI performed in office-based settings was associated with a higher hazard of repeat revascularization when compared with other settings. Differences in clinical outcomes across treatment settings and geographic regions suggest that inconsistent application of PVI may exist and highlights the need for studies to determine optimal delivery of PVI in clinical practice.
This project was funded by American Heart Association Clinical and Mentored Population Science Research Grant #14CRP18630003 awarded to Dr. Jones. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the American Heart Association. Dr. Vemulapalli has received research grants from the American College of Cardiology, the Agency for Healthcare Research and Quality, and Abbott Vascular; and has served as a consultant for Premiere, Inc. and Novella. Dr. Peterson has received research grants from the American College of Cardiology, the American Heart Association, Eli Lilly and Company, Janssen Pharmaceutical Products, and the Society of Thoracic Surgeons; and served as a consultant or advisory board member for AstraZeneca, Bayer AG, Boehringer Ingelheim, Janssen Pharmaceutical Products, Merck & Co, and Sanofi. Dr. Patel has received research grants from AstraZeneca, Johnson & Johnson, and Pluristem; and has served as a consultant for Baxter, Bayer, Genzyme, and Ortho-McNeil-Janssen. Dr. Curtis has received research grants from Novartis, GlaxoSmithKline, Boston Scientific, and Abbott; and served as a consultant/advisory board member for Amgen. Dr. Jones has received research grants from AstraZeneca, Bristol-Myers Squibb, the Doris Duke Charitable Foundation, and the Patient-Centered Outcomes Research Institute; and has served as a consultant for the American College of Radiology and Daiichi Sankyo.
- Received November 28, 2016.
- Revision received March 13, 2017.
- Accepted March 23, 2017.
- 2017 American College of Cardiology Foundation