title: Trends in hospital treatments for peripheral arterial disease in the United States and association between payer status and quality of care/outcomes, 2007-2011.
abstract: OBJECTIVE
  This study sought to identify the temporal trends of presenting diagnoses and vascular procedures performed for peripheral arterial disease (PAD) along with the rates of procedures and in-hospital outcomes by payer status.
  
  
  BACKGROUND
  Previous studies suggest that patients with Medicare, Medicaid, or lack of insurance receive poorer quality of care leading to worse outcomes.
  
  
  METHODS
  We analyzed 196,461,055 discharge records to identify all hospitalized patients with PAD records (n=1,687,724) from January 2007 through December 2011 in the Nationwide Inpatient Sample database.
  
  
  RESULTS
  The annual frequency of vascular procedures remained unchanged during the study period. Patients with Medicaid were more likely to present with gangrenes, whereas patients with Medicare were more likely to present with ulcers. After adjustment, patients with Medicare and Medicaid were more likely to undergo amputations when compared with private insurance/HMO (OR=1.13, 95% CI=1.10-1.16 and OR=1.24, 95% CI=1.20-1.29, respectively). Patients with both Medicare and Medicaid were less likely to undergo bypass surgery (OR=0.82, 95% CI=0.81-0.84 and OR=0.87, 95% CI=0.85-0.90, respectively), but more likely to undergo endovascular procedures (OR=1.18, 95% CI=1.17-1.20 and OR=1.03, 95% CI=1.01-1.06, respectively). Medicare and Medicaid status versus private insurance/HMO was associated with worse adjusted odds of in-hospital outcomes, including mortality after amputations, endovascular procedures, and bypass surgeries.
  
  
  CONCLUSIONS
  In this analysis, patients with Medicare and Medicaid had more comorbid conditions at baseline when compared with private insurance/HMO cohorts, were more likely to present with advanced stages of PAD, undergo amputations, and develop in-hospital complications. These data unveil a critical gap and an opportunity for quality improvement in the elderly and those with poor socioeconomic status.
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Luke K
authors.initials: LK
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Swaminathan
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Minutello
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Gade
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: David C
authors.initials: DC
authors.lastname: Yang
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Charitakis
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Ashish
authors.initials: A
authors.lastname: Shah
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Ryan
authors.initials: R
authors.lastname: Kaple
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Bergman
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Harsimran
authors.initials: H
authors.lastname: Singh
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: S Chiu
authors.initials: SC
authors.lastname: Wong
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York.
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000639:trends; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000592:standards / Q000639:trends*; D005260:Female; D005102:Health Expenditures / Q000639:trends; D054625:Healthcare Disparities / Q000191:economics / Q000592:standards / Q000639:trends*; D017721:Hospital Costs / Q000592:standards / Q000639:trends*; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals / Q000592:standards / Q000639:trends*; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000592:standards / Q000639:trends*; D023821:Limb Salvage / Q000639:trends; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000639:trends; D017057:Medically Uninsured; D006278:Medicare / Q000639:trends; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D017149:Private Sector / Q000639:trends; D017064:Process Assessment, Health Care / Q000191:economics / Q000592:standards / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000191:economics / Q000592:standards / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D058017:Vascular Grafting / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000639:trends*
keywords: outcomes; payer; peripheral vascular disease; trend