PMID- 37088446
OWN - NLM
STAT- MEDLINE
DCOM- 20230724
LR  - 20231025
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 78
IP  - 2
DP  - 2023 Aug
TI  - Poor utilization of palliative care among Medicare patients with chronic 
      limb-threatening ischemia.
PG  - 464-472
LID - S0741-5214(23)00541-4 [pii]
LID - 10.1016/j.jvs.2023.02.023 [doi]
AB  - OBJECTIVE: Patients with chronic limb-threatening ischemia (CLTI) experience high 
      annual mortality and would benefit from timely palliative care intervention. We 
      sought to better characterize use of palliative care among patients with CLTI in 
      the Medicare population. METHODS: Using Medicare data from 2017 to 2018, we 
      identified patients with CLTI, defined as two or more encounters with a CLTI 
      diagnosis code. Palliative care evaluations were identified using ICD-10-CM Z51.5 
      "Encounter for palliative care." Time intervals between CLTI diagnosis, 
      palliative consultation, and death or end of follow-up were calculated. 
      Associations between patient demographics, comorbidities, and palliative care 
      consultation were assessed. RESULTS: A total of 12,133 Medicare enrollees with 
      complete data were categorized as having CLTI. Of these, 7.4% (894) underwent a 
      palliative care evaluation at a median of 170 days (interquartile range, 45-352 
      days) from their CLTI diagnosis. Compared with those who did not undergo 
      evaluation, palliative patients were more likely to be dual eligible for Medicaid 
      (45.2% vs 38.1%; P < .001) and had more comorbid conditions (P < .001). After 
      controlling for gender and race, age (odds ratio [OR], 1.03; 95% confidence 
      interval [CI], 1.02-1.04), dual eligibility (OR, 1.40; 95% CI, 1.22-1.62), solid 
      organ malignancy (OR, 2.82; 95% CI, 1.92-4.14), hematologic malignancy (OR, 2.24; 
      95% CI, 1.27-3.98), congestive heart failure (OR, 1.44; 95% CI, 1.15-1.88), 
      complicated diabetes (OR, 1.35; 95% CI, 1.11-1.65), dementia (OR, 1.32; 95% CI, 
      1.04-1.66), and severe renal failure (OR, 1.56; 85% CI. 1.24-1.98) were 
      independently associated with palliative care evaluation. During mean follow up 
      of 410 +/- 220 days, 16.9% (2044) of patients died at a mean of 268 (+/-189) days 
      after their CLTI diagnosis. Among living patients, only 3.2% (325) underwent 
      palliative evaluation. Comparatively, 27.8% (569) of patients who died received 
      palliative care at a median of 196 days (interquartile range, 55-362 days) after 
      their diagnosis and 15 days (interquartile range, 5-63 days) prior to death. 
      CONCLUSIONS: Despite high mortality, palliative care services were rarely 
      provided to Medicare patients with CLTI. Age, medical complexity, and income 
      status may play a role in the decision to consult palliative care. When obtained, 
      evaluations occurred closer to time of death than to time of CLTI diagnosis, 
      suggesting misuse of palliative care as end-of-life care.
CI  - Copyright (c) 2023 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Kwong, Mimmie
AU  - Kwong M
AD  - Department of Surgery, Division of Vascular Surgery, University of California 
      Davis School of Medicine, Sacremento, CA. Electronic address: 
      mdkwong@ucdavis.edu.
FAU - Rajasekar, Ganesh
AU  - Rajasekar G
AD  - Department of Public Health Sciences, University of California Davis School of 
      Medicine, Sacremento, CA.
FAU - Utter, Garth H
AU  - Utter GH
AD  - Department of Surgery, Division of Trauma, Acute Care Surgery, and Surgical 
      Critical Care, University of California Davis School of Medicine, Sacremento, CA.
FAU - Nuno, Miriam
AU  - Nuno M
AD  - Department of Public Health Sciences, University of California Davis School of 
      Medicine, Sacremento, CA.
FAU - Mell, Matthew W
AU  - Mell MW
AD  - Department of Surgery, Division of Vascular Surgery, University of California 
      Davis School of Medicine, Sacremento, CA.
LA  - eng
PT  - Journal Article
DEP - 20230422
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
CIN - J Vasc Surg. 2023 Aug;78(2):473-474. PMID: 37481277
MH  - Humans
MH  - Aged
MH  - United States
MH  - Chronic Limb-Threatening Ischemia
MH  - Risk Factors
MH  - Palliative Care
MH  - *Peripheral Arterial Disease
MH  - *Endovascular Procedures/adverse effects
MH  - Treatment Outcome
MH  - Limb Salvage/adverse effects
MH  - Ischemia/diagnosis/therapy/etiology
MH  - Medicare
MH  - Retrospective Studies
MH  - Chronic Disease
OTO - NOTNLM
OT  - Chronic limb threatening ischemia
OT  - Hospice
OT  - Medicare
OT  - Palliative Care
OT  - Peripheral arterial disease
EDAT- 2023/04/24 00:41
MHDA- 2023/07/24 06:42
CRDT- 2023/04/23 19:36
PHST- 2022/11/15 00:00 [received]
PHST- 2023/01/20 00:00 [revised]
PHST- 2023/02/06 00:00 [accepted]
PHST- 2023/07/24 06:42 [medline]
PHST- 2023/04/24 00:41 [pubmed]
PHST- 2023/04/23 19:36 [entrez]
AID - S0741-5214(23)00541-4 [pii]
AID - 10.1016/j.jvs.2023.02.023 [doi]
PST - ppublish
SO  - J Vasc Surg. 2023 Aug;78(2):464-472. doi: 10.1016/j.jvs.2023.02.023. Epub 2023 
      Apr 22.