According to a new report from the Dartmouth Atlas Project, amputation rates show substantial variation across U.S. regions among all Medicare patients with diabetes and peripheral arterial disease (PAD), as did the use of preventive measures. The report, called “Variation in the Care of Surgical Conditions: Diabetes and Peripheral Arterial Disease,” draws on Medicare claims from 2007-2011 and divides the country into 306 regional markets defined by hospital use. The Medicare data sort patients as either black or nonblack.
The report found that amputation rates in the rural Southeast are higher than other regions of the country, and that the amputation rate for black patients is seven times higher in some regions than others, with the widest racial disparities seen in Mississippi. In almost all cases, when comparing black and nonblack patients, the lowest-risk black patients have a higher risk of amputation than nearly all nonblack patients do.
“This report leaves little doubt where the focus of amputation prevention needs to be directed,” said Philip Goodney, MD, MS, director of the Center for the Evaluation of Surgical Care at Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, who co-authored the report along with David Goodman, MD, MS, principal investigator of the Dartmouth Atlas, and other colleagues. “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….”
Not only did amputation rates vary regionally and racially, but so did the use of preventive measures. For example, only 75.2 percent of black patients with diabetes received a blood lipids test in 2010, compared to 81.5 percent of nonblack patients.
After the preventive strategies have been optimized, patients with diabetes, PAD, and wounds or ulcerations generally improve most rapidly if blood flow to their feet is restored. The rate of endovascular treatments also varied substantially across regions, from fewer than 5 procedures per 1,000 patients in Columbus, Georgia to about 34 procedures per patient in Petoskey, Michigan. The national average rate among black patients was about 20 procedures per 1,000 patients while among nonblack patients it was about 13 procedures per 1,000 patients.
Editor’s note: This story was adapted from materials provided by the Dartmouth Atlas of Health Care.