LB-7
Development & Baseline Characteristics of a 1.13M-patient longitudinal cohort to assess CLTI quality of care
Presenter
Alexander Craig Fanaroff, MD, MHS, Hospital of the University of Pennsylvania, Gladwyne, PA
Alexander Craig Fanaroff, MD, MHS1, Elias Dayoub, MD, MPP2, Lin Yang3, Kaitlyn Shultz, MS3, Omar Ramadan, MD, MSHP3, Grace Wang, MD, MSCE3, Scott Damrauer, MD3, Eric Secemsky, MD, MSc, FSCAI4, Sahil A. Parikh, MD, FSCAI5, Ashwin Nathan, M.D.6, Michael R. Jaff, D.O., FSCAI7, Peter Groeneveld, MD, MS8 and Jay S. Giri, MD, FSCAI6, (1)Hospital of the University of Pennsylvania, Gladwyne, PA, (2)Hospital of the University of Pennsylvania, Durham, NC, (3)University of Pennsylvania, Philadelphia, PA, (4)Beth Israel Deaconess Medical Center, Newton, MA, (5)NewYork-Presbyterian Columbia University Irving Medical Center, New York, NY, (6)Hospital of the University of Pennsylvania, Philadelphia, PA, (7)Massachusetts General Hospital, Delray Beach, FL, (8)The University of Pennsylvania, philadelphia, PA
Keywords: Peripheral Artery Disease (PAD), Peripheral Vascular Disease (PVD) and Quality
Background
Chronic limb-threatening ischemia (CLTI) is a common condition with high rates of morbidity and mortality, as well as racial, ethnic, socioeconomic, and geographic disparities; however, process measures for CLTI care have not been developed. We developed the Chronic Limb threatening Ischemia Process PERformance (CLIPPER) cohort to create and test quality measures for CLTI.
Methods
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 1 diagnostic code for peripheral artery disease and 1 diagnostic code for ulceration, infection, or gangrene on the same inpatient or outpatient claim, or 1 CLTI-specific diagnostic code, and a procedure code indicating arterial vascular testing within 6 months before or after the qualifying CLTI diagnostic code(s). Results
The cohort comprised 1,130,065 patients diagnosed with CLTI between 2010 and 2019. Mean (± standard deviation) 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 percutaneous or surgical revascularization. Within 6 months, 3.3% of patients underwent major amputation; 16.7% of patients died at 1-year follow-up and 50.3% at 5-year follow-up (
Figure).
Conclusions
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, gender-based, and geographic variability.
