Incidence and Surgical Procedures for Diabetes and PAD HRR Level 2014

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This report from the Dartmouth Atlas series on variation in the care of surgical conditions carefully details the scope of the problem of diabetes and peripheral arterial disease and, as in previous Atlas analyses, emphasizes geographic practice variation in both preventive services and in surgical treatment rates. The best strategies to achieve these goals are the focus of quality improvement groups in consideration of the various treatment options available. The outcomes data being recorded should go a long way toward producing the kind of widely applicable data upon which patient decision support tools should be based. This Dartmouth Atlas of Health Care series reports on unwarranted regional variation in the care of several conditions for which surgery is one important treatment option.

Complexity

As the scope and quality of surgical care continue to advance, there is still much that remains to be done to optimize care for patients. For many conditions, surgery is one of several care options, and in some instances, there are several types of surgical procedures available. Research into the effectiveness and adverse effects of a surgical procedure compared to alternatives are often incomplete. While quality has generally improved over time, outcomes can differ across hospitals and surgeons. Too often, treatment options, whether medical or surgical, are recommended without patients fully understanding the choices and participating in the decision; and these recommendations can vary markedly from one physician to the next.

Finally, the costs of care continue to rise and often differ across health care systems, even the most reputable and prestigious. Why can the “best” surgical care at one academic medical center cost twice as much as another? The next section is concerned with the care of patients after surgery, including hospital re-admissions and ambulatory care.

Patients with diabetes (high blood sugar) and peripheral arterial disease (PAD, or blockages in the arteries of the legs and other locations) are at high risk for major limb amputation at rates several times the national average for patients without diabetes. Nearly 100,000 major leg amputations are performed annually in Medicare patients, and more than half of them occur as a result of diabetes. Co-occurrence of these two illnesses—diabetes and peripheral arterial disease—has a negative synergistic effect, leaving patients at a higher risk for amputation than either of the two diseases alone.

This report reveals significant variation in the approaches to the treatment of diabetes and PAD chosen by patients and physicians. These differences are striking, not only for preventive treatments but also in the use of invasive treatments designed to limit the devastating effects of these diseases. Depending on a variety of influential factors—race, the part of the country in which they live, as well as the choices made by the physicians caring for them—patients may or may not receive important preventive care.

These efforts are needed most and will have the greatest impact, in the regions of the United States where the amputation risk is the highest. There are many regions where amputation is common, such as the rural southeastern states. In these regions, especially among black patients, the risk of amputation is several times higher than in nearly all other regions of the country. This report suggests that, while a comprehensive approach is necessary, focusing on black patients in poor, rural regions of the United States is likely to be the best place to start. This approach will have the most impact—and likely the greatest challenge towards implementation—as high limb loss rates have been a part of life for many years in rural portions of the southern United States.

Date Created

2014

Last Modified

2014-10-14

Version

1

Update Frequency

Never

Temporal Coverage

2007-2011

Spatial Coverage

United States

Source

John Snow Labs => The Dartmouth Institute

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

"The data set forth at The Dartmouth Atlas of Health Care of publication/press release was obtained from The Dartmouth Atlas, which is funded by the Robert Wood Johnson Foundation and the Dartmouth Clinical and Translational Science Institute, under award number UL1TR001086 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH)."

Keywords

Amputation Surgery, Diabetes and Amputation, Amputation Diabetes, Limb Amputation, Diabetic Toe Amputation, Diabetic Wound Care, Diabetic Ulcer Treatment, Diabetic Leg Ulcers, Leg Ulcer Treatment, Diabetic Surgery Outcomes

Other Titles

Incidence and Amputation Surgery Procedures for Diabetes and PAD HRR Level 2014, Incidence for Diabetes and Amputation HRR Level 2014, Incidence and Surgical Procedures for Diabetic Wound Care HRR Level 2014, Incidence and Surgical Procedures for Diabetic Leg Ulcers HRR Level 2014, Incidence and Surgical Procedures for Diabetes and PAD Leg Ulcer Treatment HRR Level 2014, Incidence and Surgical Procedures for Amputation Diabetes HRR Level 2014

Name Description Type Constraints
StateLocation of the State in the US where the reports of Incidence and Surgical Procedures for Diabetes and PAD are reported.stringrequired : 1
Hospital_Referral_Region_NameHospital Referral Regions (HRRs) represent regional health care markets for tertiary medical care; the regions were defined by determining where patient’s Incidence and Surgical Procedures for Diabetes and PAD are reported.stringrequired : 1
Overal_Medicare_Beneficiaries_with_Diabetes_and_PADThe total number of Medicare beneficiaries with diabetes and Peripheral Artery Disease (PAD).integerrequired : 1 level : Ratio
Black_Medicare_Beneficiaries_with_Diabetes_and_PADThe total number of Black Medicare beneficiaries with diabetes and Peripheral Artery Disease (PAD).integerlevel : Ratio
Non_Black_Medicare_Beneficiaries_with_Diabetes_and_PADThe total number of Non-Black Medicare beneficiaries with diabetes and Peripheral Artery Disease (PAD).integerlevel : Ratio
Overall_Beneficiaries_with_Leg_AmputationThe overall ratio of Medicare beneficiaries per 1000 patients with leg amputation.numberlevel : Ratio
Black_Beneficiaries_with_Leg_AmputationThe ratio of Black Medicare beneficiaries per 1000 patients with leg amputation.numberlevel : Ratio
Non_Black_Beneficiaries_with_Leg_AmputationThe ratio of Non-Black Medicare beneficiaries per 1000 patients with leg amputation.numberlevel : Ratio
Overall_Beneficiaries_with_Therapeutic_Endovascular_InterventionThe overall ratio of Medicare beneficiaries per 1000 patients with endovascular intervention.numberrequired : 1 level : Ratio
Black_Beneficiaries_with_Therapeutic_Endovascular_InterventionThe ratio of Black Medicare beneficiaries per 1000 patients with endovascular intervention.numberlevel : Ratio
Non_Black_Beneficiaries_with_Therapeutic_Endovascular_InterventionThe ratio of Non-Black Medicare beneficiaries per 1000 patients with endovascular intervention.string-
Overall_Beneficiaries_with_Open_Leg_BypassThe overall ratio of Medicare beneficiaries per 1000 patients with leg bypass.numberlevel : Ratio
Black_Beneficiaries_with_Open_Leg_BypassThe ratio of Black Medicare beneficiaries per 1000 patients with leg bypass.numberlevel : Ratio
Non_Black_Beneficiaries_with_Open_Leg_BypassThe ratio of Non-Black Medicare beneficiaries per 1000 patients with leg bypass.numberlevel : Ratio
Percent_Overall_Beneficiaries_65_75yo_with_Blood_Lipid_TestThe overall percentage of 65 to 75-year-old Medicare beneficiaries with blood lipid test.numberrequired : 1 level : Ratio
Percent_Black_Beneficiaries_65_75yo_with_Blood_Lipid_TestThe percentage of 65 to 75-year-old Black Medicare beneficiaries with blood lipid test.numberlevel : Ratio
Percent_Non_Black_Beneficiaries_65_75yo_with_Blood_Lipid_TestThe percentage of 65 to 775-year-old Non-Black Medicare beneficiaries with blood lipid test.numberlevel : Ratio
Percent_Overall_Beneficiaries_65_75yo_with_Hgb_A1c_TestThe overall percentage of 65 to 75-year-old Medicare beneficiaries with Hgb A1c test.numberrequired : 1 level : Ratio
Percent_Black_Beneficiaries_65_75yo_with_Hgb_A1c_TestThe percentage of 65 to 75-year-old Black Medicare beneficiaries with Hgb A1c test.numberlevel : Ratio
Percent_Non_Black_Beneficiaries_65_75yo_with_Hgb_A1c_TestThe percentage of 65 to 75-year-old Non-Black Medicare beneficiaries with Hgb A1c test.numberlevel : Ratio
StateHospital_Referral_Region_NameOveral_Medicare_Beneficiaries_with_Diabetes_and_PADBlack_Medicare_Beneficiaries_with_Diabetes_and_PADNon_Black_Medicare_Beneficiaries_with_Diabetes_and_PADOverall_Beneficiaries_with_Leg_AmputationBlack_Beneficiaries_with_Leg_AmputationNon_Black_Beneficiaries_with_Leg_AmputationOverall_Beneficiaries_with_Therapeutic_Endovascular_InterventionBlack_Beneficiaries_with_Therapeutic_Endovascular_InterventionNon_Black_Beneficiaries_with_Therapeutic_Endovascular_InterventionOverall_Beneficiaries_with_Open_Leg_BypassBlack_Beneficiaries_with_Open_Leg_BypassNon_Black_Beneficiaries_with_Open_Leg_BypassPercent_Overall_Beneficiaries_65_75yo_with_Blood_Lipid_TestPercent_Black_Beneficiaries_65_75yo_with_Blood_Lipid_TestPercent_Non_Black_Beneficiaries_65_75yo_with_Blood_Lipid_TestPercent_Overall_Beneficiaries_65_75yo_with_Hgb_A1c_TestPercent_Black_Beneficiaries_65_75yo_with_Hgb_A1c_TestPercent_Non_Black_Beneficiaries_65_75yo_with_Hgb_A1c_Test
IowaDubuque63153.613.73.784.992.8
IdahoIdaho Falls93148.12.572.579.3
OregonSalem636624634210.73.981.179.8
OregonBend81383281064.17.22.981.087.7
UtahProvo1266011126491.56.41.672.182.1
WisconsinWausau125002.613.48.285.090.3
WyomingCasper85342485104.110.53.653.973.6
IowaMason City1115818111402.39.64.673.387.1
WisconsinNeenah99912799644.210.75.787.292.1
MontanaBillings2414649240972.69.94.168.379.4