Lower-Extremity Endovascular Interventions for Medicare Beneficiaries: Comparative Effectiveness as a Function of Provider Specialty

Zafar, Abdul Mueed; Dhangana, Rajoo; Murphy, Timothy P.; Goodwin, Scott C.; Duszak, Richard; Ray, Charles E.; Manolov, Nikolay

doi:10.1016/j.jvir.2011.09.005

Cited by 25 publications

(12 citation statements)

References 14 publications

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“…In fact, IR-treated patients, compared with VS-treated patients, were 27% less likely to be discharged home, stayed one more day in the hospital, were 49% more likely to require major ICU use, and charged over $4000 more per inpatient hospital stay. Our findings contradict the economic and disposition findings publicized in some studies uncontrolled for clinical indication, 6 and in fact, suggest decreased resource utilization, and more likely discharge to home for patients treated by non-IR specialties. Although a detailed cost analysis was not plausible with the AHCA database, it is interesting to consider the findings of one recent study that found significant hospital cost reductions when eLEIs were performed in a radiology suite compared with the operating room.…”

Section: Discussioncontrasting

confidence: 95%

“…In a recent Journal of Vascular Interventional Radiology publication, Zafar et al proposed that the outcomes of eLEI are linked to provider specialty, and the results of their study demonstrated that VS have poorer outcomes when compared with IR and IC. 6 While a thorough critique of this study has recently been published in the Journal of Vascular Surgery , 7 two major weaknesses in the study provided the stimulus to conduct our research.…”

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confidence: 99%

“…11,12 With the inclusion of endovascular training during vascular surgery fellowships, there has been a significant increase in these procedures being performed by VS representing a widespread practice shift. 12,13 While some authors have attributed this shift primarily to financial motivations, 6 many can appreciate the patient benefit in having a vascular specialist who can offer multiple treatment modalities and follow the patient longitudinally.…”

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confidence: 99%

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Outcomes of endovascular lower extremity interventions depend more on indication than physician specialty

Wallace

Yuo

Marone

et al. 2014

Journal of Vascular Surgery

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Objective Outcomes of endovascular lower extremity interventions (eLEIs) have been recently linked to provider specialty; however, the indication for intervention was not examined. We sought to compare outcomes between specialties performing eLEI for different indications, in a recent statewide inpatient discharge dataset. Methods The Florida hospital discharge data from 2005 to 2009 were reviewed for patients with LEI during hospitalization. We assigned provider specialty as interventional radiology (IR), interventional cardiology (IC), or vascular surgery (VS) based on provider-associated procedures. Clinical indication was claudication or critical limb ischemia (CLI). We limited our analysis to patients without concomitant open surgery during hospitalization. We compared mortality, length of stay (LOS), major use of intensive care unit (ICU), discharge disposition, and total charges between specialties with regression models, both unadjusted and adjusted for demographic and clinical characteristics. Results A total of 15,398 patients (47% with CLI) had an eLEI. Clinical indication was significantly associated with provider type (P < .001) and outcomes. VS and IR were more likely than IC to treat CLI patients (VS 59%, IR 65%, IC 26%; P < .001). IC performed the majority of procedures on claudicants (VS 30%, IC 57%, IR 13%; P < .001), while VS performed the majority of procedures on CLI patients (VS 50%, IC 23%, IR 27%; P < .001). Adjusted analyses demonstrated no difference in mortality rates between the three specialties (odds ratio [OR] VS: reference, IR: 1.24, IC: 0.79; P = NS for both). However, compared with VS, IR-treated patients were less likely to be discharged home (OR, 0.74; P < .001), LOS was longer (β, 1.16 days; P < .001), major ICU use was more common (OR, 1.49; P < .001), and total charges were higher (β, $341; P = .001). CLI predicted poorer results for all outcomes: death (OR, 4.19; P < .001), discharge home (OR, 0.50; P < .001), increased LOS (β, 3.26 days; P < .001), major ICU use (OR, 1.95; P < .001), and total charges (β, $18,730; P < .001). Conclusions The majority of eLEI done by VS are for CLI, whereas the majority of patients treated by IC are claudicants. Although provider specialty does correlate with several clinical results, the clinical indication for eLEI is a stronger predictor of adverse outcomes. Future analyses of eLEI should adjust for clinical indication.

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Section: Discussioncontrasting

confidence: 95%

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confidence: 99%

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confidence: 99%

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Outcomes of endovascular lower extremity interventions depend more on indication than physician specialty

Wallace

Yuo

Marone

et al. 2014

Journal of Vascular Surgery

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“…Zafar et al used a similar methodology when they reviewed various endovascular therapies for peripheral arterial disease [25]. The LDS is a random sampling of patients and does not represent an average of the entire Medicare population.…”

Section: Discussionmentioning

confidence: 99%

Procedural Impact of a Dedicated Interventional Oncology Service Line in a National Cancer Institute Comprehensive Cancer Center

Koran

Lipnik

Baker

et al. 2016

Journal of the American College of Radiology

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Purpose We tested the hypothesis that establishing a dedicated interventional oncology (IO) clinical service line would increase clinic visits and procedural volumes at a single quaternary care academic medical center. Methods Two time periods were defined: July 2012 to June 2013 (pre-IO clinic) and July 2013 to June 2014 (first year of dedicated IO service). Staff was recruited, and clinic space was provided in the institution’s comprehensive cancer center. Clinic visits and procedure numbers were documented using the institution’s electronic medical record and billing forms. IO procedures included were transarterial chemoembolization, Y-90 radioembolization, perfusion mapping for Y-90, portal vein embolization, and bland embolization. We compared changes in clinic visit and procedure numbers using paired t tests. Changes after IO initiation were compared to 1-year changes in the Medicare 5% Limited Data Set by cross-referencing Current Procedure Terminology and International Classification of Diseases codes in 2012 and 2013. Results Clinic visits increased from 9 to 204 (P = .003, t = 8.89, df = 3). Procedures increased from 60 to 239 (P = .018, t = 3.85, df = 4). Procedural volumes increased at least 150% for each subtype. The volumes in the 5% Limited Data Set did not change significantly over the 2-year period (443 to 385, P > .05). Conclusions The establishment of a dedicated IO service significantly increased clinic visits and procedural volumes. National trends were unchanged, suggesting that the impact of our program was not part of a sudden increase of IO procedures.

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“…Ring and Keran in 1985 predicted that “The development of interventional radiology (IR) services that provide inpatient and outpatient care will establish IR as an important primary service and improve patient care.” [ 1 ] IR is steadily on the rise as the discipline of choice to diagnose and treat a vast array of vascular, oncologic and neurologic conditions, performing procedures such as thrombectomy, intra-arterial chemotherapy and embolization, and central venous access. Compared with surgical techniques, IR procedures are less invasive and often safer [ 2 ] and are considered among “some of the more cost- effective procedures in medicine today” [ 3 ], providing high clinical value defined by balancing cost with clinical benefits such as clinical outcomes (lives saved, complication rates, recovery periods, and duration of hospital stays), quality-adjusted life-years, years off dialysis, etc.…”

Section: Introductionmentioning

confidence: 99%

The new Interventional Radiology/Diagnostic Radiology dual certificate: “higher standards, better education”

Marco

Anderson

2016

Insights Imaging

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The American Board of Medical Specialties (ABMS) has approved a “new” residency: dual Certification in Interventional Radiology (IR) / Diagnostic Radiology (DR). This IR/DR program intends to better prepare future IR doctors. Residency programs can apply for the IR/DR program beginning in 2015, with full nationwide implementation of the IR/DR residency likely to ramp up by 2022. The IR/DR dual certificate can be attained via an “Integrated” or “Independent” IR/DR residency pathway. The IR/DR training pathway may lead the way to the future training of IR/DR physicians worldwide. Certainly, the ABMS approval of a “new” residency is rare and worth attention; however, as with all things new, questions and concerns will be raised.Main messages• The ABMS approved a “new” residency, the IR/DR dual Certification.• This IR/DR program intends to better prepare future IR doctors.• Full nationwide implementation of the IR/DR Residency is likely by 2022.• The IR/DR certificate can be attained via the Integrated or the Independent residency pathway.• These programs may lead the way to the future training of IR/DR physicians worldwide.

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Lower-Extremity Endovascular Interventions for Medicare Beneficiaries: Comparative Effectiveness as a Function of Provider Specialty

Cited by 25 publications

References 14 publications

Outcomes of endovascular lower extremity interventions depend more on indication than physician specialty

Outcomes of endovascular lower extremity interventions depend more on indication than physician specialty

Procedural Impact of a Dedicated Interventional Oncology Service Line in a National Cancer Institute Comprehensive Cancer Center

The new Interventional Radiology/Diagnostic Radiology dual certificate: “higher standards, better education”

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