Moses D A, Mehaffey J H, Strider D V, Tracci M C, Kern J A, Upchurch G R
Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville, VA.
Division of Vascular and Endovascular Surgery, University of Virginia Health System, Charlottesville, VA.
Ann Vasc Surg. 2017 Jul;42:214-221. doi: 10.1016/j.avsg.2016.12.019. Epub 2017 Apr 5.
Cigarette smoking is strongly associated with atherosclerotic disease. It is incumbent on vascular surgeons to provide smoking cessation counseling (SCC) to their patients. The objective of this study was to determine the association of SCC and improvement in quality of care.
As a quality project using retrospective data, the study received institutional review board exemption status. A retrospective review of prospectively maintained database from April 2014 through March 2015 of outpatient encounters in a vascular surgery clinic was performed of current smokers. Through the quality support team, providers were encouraged to counsel smokers to quit, document the discussion, and bill specific Evaluate and Management codes (99406 and 99407). The number of outpatients by smoking status, documentation and billing of SCC, demographics of current smokers, and monetary collections were collected. Data were compared using a correlation coefficient calculated and tested for statistical significant using two-tailed t-test.
A sample of 1,077 visits by 612 currently smoking patients accounted for 24% of all outpatient vascular surgery visits. The average age was 61 years, and 64% were male. Comorbidities included 77% with hypertension, 32% with diabetes mellitus, and 14% with chronic kidney disease. Medically, 72% were on aspirin, 71% on statin, and 48% on beta blocker. A total of 208 (34%) never underwent a vascular intervention, and 183 (30%) had an intervention during the study period (44% for peripheral artery disease, 10% for carotid stenosis, 14% amputations, and 10% abdominal aortic aneurysm). Documentation improved from 65% of encounters during the first month to 89% in the peak month and 79% of total encounters. All-cause mortality rate was 2%, and this cohort demonstrated 75% SCC for 28 encounters. Fifty-five patients (9%) quit smoking for more than 30 days at the end of the study period, and this cohort had 69% of their 97 encounters with documented SCC. Increased SCC was correlated with decreased 30-day readmissions during the concurrent month (r = -0.711, P = 0.009) and the following month (r = -0.719, P = 0.008). There was a weak correlation with decreased amputations the following month (r = -0.5, P = 0.08). From a financial perspective, $1,373 was collected for 33 patients with a potential for collection of $7,460 predicted for minimum Medicare payment of 1 visit per patient.
Advising vascular patients in the arduous process of smoking cessation benefits both the patient and the health system. Proper documentation and billing decreases costs of early readmissions and increases departmental revenue.
吸烟与动脉粥样硬化性疾病密切相关。血管外科医生有责任为患者提供戒烟咨询（SCC）。本研究的目的是确定SCC与医疗质量改善之间的关联。
作为一项使用回顾性数据的质量项目，该研究获得了机构审查委员会的豁免。对2014年4月至2015年3月期间血管外科门诊前瞻性维护数据库中现吸烟者的门诊情况进行了回顾性分析。通过质量支持团队，鼓励医护人员为吸烟者提供戒烟咨询，记录讨论内容，并开具特定的评估和管理代码（99406和99407）。收集了按吸烟状况分类的门诊患者数量、SCC的记录和计费情况、现吸烟者的人口统计学信息以及货币收入。使用计算出的相关系数进行数据比较，并通过双尾t检验检验统计学显著性。
612名现吸烟患者的1077次就诊占所有血管外科门诊就诊的24%。平均年龄为61岁，64%为男性。合并症包括77%患有高血压，32%患有糖尿病，14%患有慢性肾脏病。在药物治疗方面，72%服用阿司匹林，71%服用他汀类药物，48%服用β受体阻滞剂。共有208名（34%）患者从未接受过血管干预，183名（30%）患者在研究期间接受了干预（外周动脉疾病占44%，颈动脉狭窄占10%，截肢占14%，腹主动脉瘤占10%）。记录情况从第一个月的65%的就诊有所改善，在高峰期月份达到89%，占总就诊次数的79%。全因死亡率为2%，该队列中有28次就诊（75%）进行了SCC。在研究期结束时，55名患者（9%）戒烟超过30天，在这97次就诊中，该队列中有69%有SCC记录。SCC增加与同期当月（r = -0.711，P = 0.009）和次月（r = -0.719，P = 0.008）30天再入院率降低相关。与次月截肢率降低存在弱相关性（r = -0.5，P = 0.08）。从财务角度来看，为33名患者收取了1373美元，预计每位患者至少就诊1次的医疗保险最低支付额为7460美元。
在戒烟这一艰巨过程中为血管疾病患者提供建议对患者和医疗系统都有益。适当的记录和计费可降低早期再入院成本并增加科室收入。
