Abstract 14: Intensity of Vascular Care for PAD: More Spending, But Not Fewer Amputations.

Abstract

Introduction: While significant disparities exist in the care of patients with severe PAD, the relationship between the intensity of vascular care, spending, and limb salvage remains unclear. Methods: We studied the vascular care provided to 20,058 Medicare patients in the year prior to amputation for critical limb ischemia, using the 306 hospital referral regions (HRRs) as defined in the Dartmouth Atlas of Healthcare. We examined associations between the intensity of vascular care (defined as the number of revascularization procedures or vascular-related admissions in the year prior to amputation), price-adjusted Medicare spending, and population-based amputation rates. Results: Overall, 54% of patients did not undergo any revascularization in the year prior to amputation. Of the 46% who underwent open or endovascular revascularization, 18% had one procedure, and 28% had more than one revascularization procedure. Among patients who underwent revascularization, the mean regional cost of vascular care in the year prior to amputation was $14,155, such as in Gainesville FL (Figure, Panel A). However, in HRRs where at least 25 patients underwent amputation, spending on vascular care in the year prior to amputation varied from $9,475 (Bismarck, North Dakota) to $26,787 (St. Paul, Minnesota). The intensity of vascular care, as measured by procedures and hospitalizations, was well correlated with spending (r=0.36), but higher spending was not associated with lower population-based amputation rates (r=0.07) (Figure, Panel B). Conclusion: While Medicare spending is directly related to the intensity of vascular care, there is little evidence to suggest that higher spending is associated with lower population-based rates of amputation. Future health policy is needed to better direct Medicare spending for patients at risk for amputation.