Department of Surgery, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
JACC Cardiovasc Interv. 2017 Jun 12;10(11):1161-1171. doi: 10.1016/j.jcin.2017.03.033.
Modifications in reimbursement rates by Medicare in 2008 have led to peripheral vascular interventions (PVI) being performed more commonly in outpatient and office-based clinics. The objective of this study was to determine the effects of this shift in clinical care setting on clinical outcomes after PVI.
Modifications in reimbursement have led to peripheral vascular intervention (PVI) being more commonly performed in outpatient hospital settings and office-based clinics.
Using a 100% national sample of Medicare beneficiaries from 2010 to 2012, we examined 30-day and 1-year rates of all-cause mortality, major lower extremity amputation, repeat revascularization, and all-cause hospitalization by clinical care location of index PVI.
A total of 218,858 Medicare beneficiaries underwent an index PVI between 2010 and 2012. Index PVIs performed in inpatient settings were associated with higher 1-year rates of all-cause mortality (23.6% vs. 10.4% and 11.7%; p < 0.001), major lower extremity amputation (10.1% vs. 3.7% and 3.5%; p < 0.001), and all-cause repeat hospitalization (63.3% vs. 48.5% and 48.0%; p < 0.001), but lower rates of repeat revascularization (25.1% vs. 26.9% vs. 38.6%; p < 0.001) when compared with outpatient hospital settings and office-based clinics, respectively. After adjustment for potential confounders, patients treated in office-based clinics remained more likely than patients in inpatient hospital settings to require repeat revascularization within 1 year across all specialties. There was also a statistically significant interaction effect between location of index revascularization and geographic region on the occurrence of all-cause hospitalization, repeat revascularization, and lower extremity amputation.
Index PVI performed in office-based settings was associated with a higher hazard of repeat revascularization when compared with other settings. Differences in clinical outcomes across treatment settings and geographic regions suggest that inconsistent application of PVI may exist and highlights the need for studies to determine optimal delivery of PVI in clinical practice.
2008 年医疗保险报销费率的调整使得外周血管介入（PVI）更多地在门诊和诊所进行。本研究的目的是确定临床治疗环境的这种转变对外周血管介入后临床结果的影响。
报销费率的调整使得外周血管介入（PVI）更多地在门诊医院环境和诊所进行。
使用 2010 年至 2012 年 Medicare 受益人的全国 100%样本，我们根据 PVI 索引的临床治疗地点，检查了 30 天和 1 年的全因死亡率、主要下肢截肢、重复血运重建和全因住院率。
共有 218858 名 Medicare 受益人的 PVI 索引在 2010 年至 2012 年之间进行。在住院环境中进行的 PVI 索引与更高的 1 年全因死亡率（23.6%比 10.4%和 11.7%；p<0.001）、主要下肢截肢（10.1%比 3.7%和 3.5%；p<0.001）和全因再次住院（63.3%比 48.5%和 48.0%；p<0.001）相关，但与门诊医院环境和诊所相比，重复血运重建的比率较低（25.1%比 26.9%和 38.6%；p<0.001）。在调整了潜在的混杂因素后，与住院医院环境相比，在所有专科中，在诊所接受治疗的患者在 1 年内再次血运重建的可能性仍然更高。索引血运重建的位置和地理区域之间也存在显著的交互作用，影响全因住院、重复血运重建和下肢截肢的发生。
与其他环境相比，在诊所进行的 PVI 索引与更高的重复血运重建风险相关。治疗环境和地理区域之间的临床结果差异表明，可能存在 PVI 的不一致应用，并强调需要研究确定 PVI 在临床实践中的最佳应用。
