Austin Andrea M, Chakraborti Gouri, Columbo Jesse, Ramkumar Niveditta, Moore Kayla, Scheurich Michelle, Goodney Phil
The Dartmouth Institute, Dartmouth College, Lebanon, New Hampshire, USA.
Analytics Institute, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
BMJ Surg Interv Health Technol. 2019 Jul;1(1):e000018. doi: 10.1136/bmjsit-2019-000018.
To determine whether patients from the Vascular Quality Initiative (VQI) registry who are Medicare-Medicaid dual-eligible have outcomes after surgical intervention with medical devices such as stents for peripheral artery disease comparable to the outcomes of those eligible for Medicare alone.
The study cohort included fee-for-service Medicare beneficiaries from 2010 to 2015 who underwent peripheral vascular intervention as determined by the VQI. We performed propensity matching between the dual-eligible and non-dual-eligible cohorts. Postintervention use, including imaging, amputation and death, was determined using Medicare claims data.
Rates of major amputation were higher among dual-eligible patients (13.0% vs 10.5%, p<0.001), while time to amputation by disease severity was similar (p=0.443). For patients with more advanced disease (critical limb ischaemia (CLI) vs claudication), dual-eligible patients have significantly faster times to any amputation and death (p<0.001). For of postoperative imaging, 48.4% of dual-eligible patients receive at least one postoperative image, while the percentage for non-dual-eligible patients is 47.2% (p=0.187).
Patients with mild forms of peripheral artery disease (PAD), such as claudication, demonstrated similar outcomes regardless of dual-eligibility status. However, those with severe PAD, such as CLI, who were also dual-eligible had both inferior overall survival and amputation-free survival. Minimal differences were observed in process-driven aspects of care between dual-eligible and non-dual-eligible patients, including postoperative imaging. These findings indicate that despite receiving similar care, dual-eligible patients with severe PAD have inferior long-term outcomes, suggesting the Medicaid safety net is not timely enough to benefit from long-term outcomes for these patients.
确定血管质量倡议（VQI）登记处中符合医疗保险和医疗补助双重资格的患者在接受诸如外周动脉疾病支架等医疗器械手术干预后的结局，是否与仅符合医疗保险资格的患者的结局相当。
研究队列包括2010年至2015年按服务收费的医疗保险受益人，这些人接受了VQI确定的外周血管干预。我们在双重资格队列和非双重资格队列之间进行了倾向匹配。使用医疗保险理赔数据确定干预后的使用情况，包括成像、截肢和死亡情况。
双重资格患者的大截肢率较高（13.0%对10.5%，p<0.001），而按疾病严重程度划分的截肢时间相似（p=0.443）。对于病情更严重的患者（严重肢体缺血（CLI）与间歇性跛行），双重资格患者的任何截肢和死亡时间明显更快（p<0.001）。在术后成像方面，48.4%的双重资格患者至少接受了一次术后影像检查，而非双重资格患者的这一比例为47.2%（p=0.187）。
患有轻度外周动脉疾病（PAD）（如间歇性跛行）的患者，无论其双重资格状态如何，结局相似。然而，患有严重PAD（如CLI）且具有双重资格的患者，其总体生存率和无截肢生存率均较差。在双重资格和非双重资格患者之间，包括术后成像在内的护理过程驱动方面观察到的差异极小。这些发现表明，尽管接受了相似的护理，但患有严重PAD的双重资格患者的长期结局较差，这表明医疗补助安全网不够及时，无法使这些患者从长期结局中获益。
