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Regional availability of specialists affects outcomes for patients with peripheral arterial disease

Peripheral arterial disease (PAD) is caused by atherosclerosis (blocked arteries) in the lower extremities. PAD prevents oxygen from reaching extremity tissues, causing pain, ulceration, and even gangrene, and sometimes leads to amputation. Bypass surgery or angioplasty can be used to restore circulation in the affected limbs to prevent amputation, but the likelihood that a patient will receive these procedures is often dependent on access to vascular specialists. Increasing the supply of vascular specialists who perform bypass surgery and interventional radiologists who perform angioplasty may help reduce amputations in patients with PAD in underserved areas, suggests a study supported by the Agency for Healthcare Research and Quality (HS11501).

Vivian Ho, Ph.D., of Rice University and Baylor College of Medicine, and colleagues identified elderly patients with PAD in the 1994 Medicare claims database and tracked their claims through 1999. They merged risk-adjusted data by Hospital Referral Region on 143,202 patients who survived through 1999 with information on local physician supply and other regional characteristics. Their goal was to test whether regional availability of vascular surgeons and interventional radiologists affected lower extremity bypass surgery or angioplasty and amputation rates for patients with PAD.

They found that increasing vascular surgeon supply in a region by about one standard deviation (.30/10,000 Medicare beneficiaries) was associated with a 0.9 percentage point increase in bypass surgery rates and a 1.6 percentage point reduction in amputation rates. They found weaker evidence that greater availability of interventional radiologists increased angioplasty rates and reduced amputation rates. Regions considered more attractive, by virtue of good climate, low crime, and other factors, were more likely to have a larger supply of vascular surgeons and interventional radiologists.

See "Physician supply, treatment, and amputation rates for peripheral arterial disease," by Dr. Ho, Douglas Wirthlin, M.D., Huifeng Yun, M.S., and Jeroan Allison, M.D., in the July 2005 Journal of Vascular Surgery 42, pp. 81-87.

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