Eliminating Sex-Based Disparities in Statin Prescriptions Following Open Revascularization for CLTI Through Universal Documentation

Abstract

Women have been shown to have worse clinical outcomes compared with men following treatment for peripheral arterial disease. Although the reasons for this remain unclear, disparities in evidence-based medical management have been suggested as one potential cause. As a part of the Northern California Vascular Quality Initiative (VQI) regional collaborative, a universal discharge documentation quality improvement initiative was implemented to address discharge medication prescriptions. We hypothesized that implementation of universal discharge documentation would decrease disparities in statin prescription after open vascular procedures for chronic limb-threatening ischemia (CLTI). A single-center retrospective analysis was performed using electronic health record warehouse data extraction with medical record review auditing. Patients with CLTI who had undergone open lower extremity bypass or femoral endarterectomy from 2012 to 2020 were included. The primary end point was a statin prescription within 30 days after the procedure. A time series analysis was performed comparing the primary end point before and after implementation of universal discharge documentation in May 2018. Sex was defined as the birth sex as reported in the medical record. Logistic regression was used to estimate the associated change in statin prescription by sex. A total of 357 cases were included, with 144 women (40%) and 213 men (60%). Before implementation, statins had been prescribed to 87% of the men and 69% of the women (P < .01). After implementation of the universal discharge documentation, there was no difference in statin prescription (88% for men vs 95% for women; P = .19). On logistic regression, men had 3.0 times the odds of being prescribed a statin before implementation (odds ratio, 3.0; 95% confidence interval, 1.6-5.6; P < .01). Following implementation of the initiative, the improvement in the odds of women receiving statins was eight times that of men (odds ratio, 8.2; 95% confidence interval, 1.5-46.1; P = .02). Implementation of universal discharge documentation eliminated sex-based disparities in discharge statin prescription following open revascularization for CLTI. These findings suggest that regional VQI initiatives aimed at improving discharge documentation might also play an important role in addressing disparities in vascular care. Future study is necessary to better understand how universal discharge documentation might affect sex-related and other disparities across VQI modules at the regional level.