Outcomes after peripheral artery disease intervention among Medicare–Medicaid dual-eligible patients compared with the general medicare population in the Vascular Quality Initiative registry. Issue 1 (26th November 2019)

• Record Type: Journal Article
• Authors: Austin, Andrea M; Chakraborti, Gouri; Columbo, Jesse; Ramkumar, Niveditta; Moore, Kayla; Scheurich, Michelle; Goodney, Phil
• Is Part Of: BMJ surgery, interventions, & health technologies. Volume 1:Issue 1(2019)
• Publication Date: 2019-11-26
• Subjects: process assessment (healthcare) -- outcomes research -- health services research; Surgery -- Periodicals; Surgery -- Research -- Periodicals; Medical care -- Periodicals; Medical care -- Research -- Periodicals; 617.005
• DOI: 10.1136/bmjsit-2019-000018
• Languages: English
• ISSNs: 2631-4940

Abstract

Abstract : Objective: 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. Methods: 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. Results: 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). Conclusions: 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.