Mid-South Imaging and Therapeutics, 6305 Humphreys Boulevard, Memphis, TN 38120, USA.
J Am Coll Radiol. 2010 Dec;7(12):937-42. doi: 10.1016/j.jacr.2010.03.021.
The aim of this study was to evaluate the changing relative roles of radiologists, nephrologists, and surgeons performing endovascular hemodialysis access maintenance procedures.
Medicare Physician Supplier Procedure Summary Master Files from 2001 through 2008 were analyzed for procedure codes for hemodialysis access angiography, angioplasty, percutaneous thrombectomy, and open surgical interventions. Using physician specialty code data, component procedure volume for all 3 endovascular services was extracted for radiologists, nephrologists, and surgeons. Percentage changes were calculated for all groups. National trends in percutaneous and open interventions were compared.
Between 2001 and 2008, the total Medicare fee-for-service component procedure volume for dialysis access angiography, angioplasty, and percutaneous thrombectomy increased by 102%, 171%, and 52%, respectively. In 2008, radiologists performed 50% of angiography, 47% of angioplasty, and 46% of declotting procedures, down from 82%, 82%, and 84%, respectively, in 2001. In contrast, nephrologists increased from 4%, 5%, and 4% to 22%, 27%, and 21% of services, and surgeons increased from 7%, 5%, and 4% to 22%, 19%, and 16%. As percutaneous procedures increased in frequency, open surgical interventions declined by 43%.
Nationally, endovascular hemodialysis access maintenance procedures have increased as open surgical interventions have declined. Nephrologists and surgeons have both experienced marked relative increases in endovascular procedure volumes as radiologists, previously by far the predominant providers of these services, now only perform approximately half.
本研究旨在评估血管内血液透析通路维护程序中放射科医生、肾脏病学家和外科医生的相对角色变化。
分析了 2001 年至 2008 年医疗保险医师供应商程序摘要主文件中的血液透析通路血管造影、血管成形术、经皮血栓切除术和开放手术干预程序代码。使用医师专业代码数据，提取了所有 3 种血管内服务的放射科医生、肾脏病学家和外科医生的部分程序量。计算了所有组别的百分比变化。比较了经皮和开放干预的全国趋势。
2001 年至 2008 年间，透析通路血管造影、血管成形术和经皮血栓切除术的总医疗保险费用服务部分程序量分别增加了 102%、171%和 52%。2008 年，放射科医生分别进行了 50%的血管造影、47%的血管成形术和 46%的溶栓程序，而 2001 年这一比例分别为 82%、82%和 84%。相比之下，肾脏病学家的服务量从 4%、5%和 4%增加到 22%、27%和 21%，外科医生的服务量从 7%、5%和 4%增加到 22%、19%和 16%。随着经皮程序的频率增加，开放手术干预减少了 43%。
全国范围内，血管内血液透析通路维护程序增加，而开放手术干预减少。肾脏病学家和外科医生的血管内程序量都明显增加，而放射科医生（以前是这些服务的主要提供者）现在只进行大约一半的程序。
