PMID- 38098680
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231216
IS  - 2468-4287 (Print)
IS  - 2468-4287 (Electronic)
IS  - 2468-4287 (Linking)
VI  - 9
IP  - 4
DP  - 2023 Dec
TI  - Adherence to vascular care guidelines for emergency revascularization of chronic 
      limb-threatening ischemia.
PG  - 101299
LID - 10.1016/j.jvscit.2023.101299 [doi]
LID - 101299
AB  - OBJECTIVE: In 2022, the National Health Service Commissioning for Quality and 
      Innovation (CQUIN) indicator for vascular surgery, with its pay-for-performance 
      incentive for timely (5-day) revascularization of chronic limb-threatening 
      ischemia (CLTI), was introduced. We sought to assess its effects in terms of (1) 
      changes in the care pathway process measures relating to timing and patient 
      outcomes; and (2) adherence to the Peripheral Arterial Disease Quality 
      Improvement Framework (PAD-QIF) guidelines for patients admitted with CLTI. 
      METHODS: A retrospective before-and-after cohort study was performed from January 
      to June 2022 of nonelective admissions for CLTI who underwent revascularization 
      (open, endovascular, or hybrid) at Cambridge University Hospitals National Health 
      Service Foundation Trust, a regional vascular "hub." The diagnostic and treatment 
      pathway timing-related process measures recommended in the PAD-QIF were compared 
      between two 3-month cohorts-before vs after introduction of the CQUIN. RESULTS: 
      For the two cohorts (before vs after CQUIN), 17 of 223 and 17 of 219 total 
      admissions met the inclusion criteria, respectively. After introduction of 
      financial incentives, the percentage of patients meeting the 5-day targets for 
      revascularization increased from 41.2% to 58.8% (P = .049). Improvements were 
      also realized in the attainment of PAD-QIF targets for a referral-to-admission 
      time of </=2 days (from 82.4% to 88.8%; P = .525) and 
      admission-to-specialist-review time of </=14 hours (from 58.8% to 76.5%; P = .139). 
      An increase also occurred in the percentage of patients receiving imaging studies 
      within 2 days of referral (from 58.8% to 70.6%; P = .324). The reasons for delay 
      included operating list pressures and unsuitability for intervention (eg, active 
      COVID-19 [coronavirus disease 2019] infection). No statistically significant 
      changes to patient outcomes were observed between the two cohorts in terms of 
      complications (pre-CQUIN, 23.5%; post-CQUIN, 41.2%; P = .086), length of stay 
      (pre-QUIN, 12.0 +/- 12.0 days; post-QUIN, 15.0 +/- 21.0 days; P = .178), and 
      in-hospital mortality (pre-QUIN, 0%; post-QUIN, 5.9%). Other PAD-QIF targets 
      relating to delivery of care were poorly documented for both cohorts. These 
      included documented staging of limb threat severity with the WIfI (wound, 
      ischemia, foot infection) score (2.9% of patients; target >80%), documented 
      shared decision-making (47.1%; target >80%), documented issuance of written 
      information to patient (5.9%; target 100%), and geriatric assessment (6.3%; 
      target >80%). CONCLUSIONS: The pay-for-performance incentive CQUIN indicators 
      appear to have raised the profile for the need for early revascularization to 
      treat CLTI, engaging senior hospital management, and reducing the time to 
      revascularization in our cohort. Further data collection is required to detect 
      any resultant changes in patient outcomes. Documentation of guideline targets for 
      delivery of care was often poor and should be improved.
CI  - (c) 2023 The Authors.
FAU - Speirs, Toby P
AU  - Speirs TP
AD  - Department of Vascular Surgery, Cambridge University Hospitals, Queens' College, 
      Cambridge, UK.
AD  - School of Clinical Medicine, University of Cambridge, Cambridge, UK.
FAU - Atkins, Eleanor
AU  - Atkins E
AD  - Department of Vascular Surgery, Cambridge University Hospitals, Queens' College, 
      Cambridge, UK.
AD  - Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
FAU - Chowdhury, Mohammed M
AU  - Chowdhury MM
AD  - Department of Vascular Surgery, Cambridge University Hospitals, Queens' College, 
      Cambridge, UK.
AD  - Department of Surgery, School of Clinical Medicine, University of Cambridge, 
      Cambridge, UK.
FAU - Hildebrand, Diane R
AU  - Hildebrand DR
AD  - Department of Vascular Surgery, Cambridge University Hospitals, Queens' College, 
      Cambridge, UK.
FAU - Boyle, Jonathan R
AU  - Boyle JR
AD  - Department of Vascular Surgery, Cambridge University Hospitals, Queens' College, 
      Cambridge, UK.
AD  - Department of Surgery, School of Clinical Medicine, University of Cambridge, 
      Cambridge, UK.
LA  - eng
PT  - Journal Article
DEP - 20230825
PL  - United States
TA  - J Vasc Surg Cases Innov Tech
JT  - Journal of vascular surgery cases and innovative techniques
JID - 101701125
PMC - PMC10719409
OTO - NOTNLM
OT  - Amputation
OT  - Chronic limb-threatening ischemia
OT  - Diabetic foot
OT  - Intermittent claudication
OT  - Peripheral arterial disease
EDAT- 2023/12/15 06:42
MHDA- 2023/12/15 06:43
PMCR- 2023/08/25
CRDT- 2023/12/15 03:49
PHST- 2022/12/31 00:00 [received]
PHST- 2023/05/08 00:00 [accepted]
PHST- 2023/12/15 06:43 [medline]
PHST- 2023/12/15 06:42 [pubmed]
PHST- 2023/12/15 03:49 [entrez]
PHST- 2023/08/25 00:00 [pmc-release]
AID - S2468-4287(23)00208-3 [pii]
AID - 101299 [pii]
AID - 10.1016/j.jvscit.2023.101299 [doi]
PST - epublish
SO  - J Vasc Surg Cases Innov Tech. 2023 Aug 25;9(4):101299. doi: 
      10.1016/j.jvscit.2023.101299. eCollection 2023 Dec.