Fanaroff Alexander C, Dayoub Elias J, Yang Lin, Shultz Kaitlyn, Ramadan Omar I, Genovese Elizabeth A, Wang Grace J, Damrauer Scott M, Secemsky Eric A, Parikh Sahil A, Nathan Ashwin S, Jaff Michael R, Groeneveld Peter W, Giri Jay
Cardiovascular Medicine Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.
J Soc Cardiovasc Angiogr Interv. 2023 May 19;2(4):100982. doi: 10.1016/j.jscai.2023.100982. eCollection 2023 Jul-Aug.
Chronic limb-threatening ischemia (CLTI) is a common condition with high rates of morbidity and mortality. Despite extensive literature documenting poor outcomes in patients with CLTI, as well as racial, ethnic, socioeconomic, and geographic disparities in these outcomes, process measures for high-quality CLTI care have not been developed. We developed the Chronic Limb threatening Ischemia Process PERformace (CLIPPER) cohort to develop and test the validity of CLTI care quality measures.
Using inpatient and outpatient claims data from patients with fee-for-service Medicare from 2010 to 2019, we created a coding algorithm to identify patients with CLTI. To qualify for a CLTI diagnosis, patients had to have either diagnostic codes for peripheral artery disease and for ulceration, infection, or gangrene on the same inpatient or outpatient claim or a CLTI-specific diagnostic code. Patients were also required to have a procedural code indicating arterial vascular testing within 6 months before or after the earliest qualifying CLTI diagnostic code(s). We describe baseline characteristics and long-term outcomes of this cohort.
The final cohort comprised 1,130,065 patients diagnosed with CLTI between 2010 and 2019. Mean (±SD) age of the cohort was 75 ± 5.8 years; 48.4% were women, and 14.6% were Black. Within 30 days of CLTI diagnosis, 20.4% of patients underwent either percutaneous or surgical revascularization. Within 6 months, 3.3% of patients underwent major amputation; 16.7% of patients died within 1 year and 50.3% within 5 years.
We described the development of a cohort of fee-for-service Medicare patients with CLTI using inpatient and outpatient Medicare claims data. CLIPPER will be a resource for developing a set of process measures that can be captured from administrative claims data, with plans to describe their association with limb outcomes and corresponding racial, ethnic, socioeconomic, sex-based, and geographic variability.
慢性肢体威胁性缺血（CLTI）是一种常见疾病，发病率和死亡率很高。尽管有大量文献记录了CLTI患者的不良预后，以及这些预后在种族、民族、社会经济和地理方面的差异，但尚未制定高质量CLTI护理的过程指标。我们建立了慢性肢体威胁性缺血过程绩效（CLIPPER）队列，以开发和测试CLTI护理质量指标的有效性。
利用2010年至2019年服务收费型医疗保险患者的住院和门诊理赔数据，我们创建了一种编码算法来识别CLTI患者。要符合CLTI诊断标准，患者必须在同一次住院或门诊理赔中同时有外周动脉疾病以及溃疡、感染或坏疽的诊断代码，或者有CLTI特定的诊断代码。患者还需要有一个程序代码，表明在最早符合CLTI诊断代码之前或之后6个月内进行了动脉血管检测。我们描述了该队列的基线特征和长期预后。
最终队列包括2010年至2019年期间诊断为CLTI的1,130,065名患者。该队列的平均（±标准差）年龄为75±5.8岁；48.4%为女性，14.6%为黑人。在CLTI诊断后的30天内，20.4%的患者接受了经皮或手术血运重建。在6个月内，3.3%的患者接受了大截肢手术；16.7%的患者在1年内死亡，50.3%在5年内死亡。
我们描述了使用住院和门诊医疗保险理赔数据建立服务收费型医疗保险CLTI患者队列的过程。CLIPPER将成为开发一套可从行政理赔数据中获取的过程指标的资源，计划描述这些指标与肢体预后的关联以及相应的种族、民族、社会经济、性别和地理差异。
