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    Physician supply, treatment, and amputation rates for peripheral arterial disease

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    Authors
    Ho, Vivian
    Wirthlin, Douglas
    Yun, Huifeng
    Allison, Jeroan J.
    UMass Chan Affiliations
    Department of Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2005-07-14
    Keywords
    Aged
    Amputation
    Female
    General Surgery
    Humans
    Least-Squares Analysis
    Male
    Medicare
    Peripheral Vascular Diseases
    Physicians
    Radiology, Interventional
    Bioinformatics
    Biostatistics
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1016/j.jvs.2005.03.023
    Abstract
    OBJECTIVE: To test whether the availability of vascular surgeons and interventional radiologists in a region affects revascularization and amputation rates for patients with peripheral arterial disease (PAD). METHODS: We identified all patients with PAD in the Medicare claims database in 1994 and tracked their claims through 1999. We aggregated risk-adjusted data on the 143,202 patients who survived through 1999 by Hospital Referral Region and merged this data with information on local physician supply and other regional characteristics. Instrumental variables analysis was used to account for unobserved illness severity. Main outcome measures were risk-adjusted rates of lower extremity bypass surgery, angioplasty, and amputation by region. RESULTS: Increasing vascular surgeon supply in a region by approximately one standard deviation (.30/10,000 Medicare beneficiaries) is associated with a 0.9 percentage point increase in bypass surgery rates and a 1.6 percentage point reduction in amputation rates. We find weaker evidence that greater availability of interventional radiologists increases angioplasty rates and reduces amputation rates. Factors reflecting regional attractiveness, such as the rating of a region based on climate, recreation, crime, and other attributes, were strong independent predictors of the number of vascular surgeons and interventional radiologists in an area. CONCLUSIONS: Availability of specialists affects outcomes for PAD patients. Regional variability in specialists who treat PAD is influenced by factors other than regional medical needs. Policies aimed at increasing the supply of vascular surgeons and interventional radiologists and their provision of bypass surgery in underserved areas may help to reduce regional disparities in amputation.
    Source
    J Vasc Surg. 2005 Jul;42(1):81-7. Link to article on publisher's site
    DOI
    10.1016/j.jvs.2005.03.023
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47666
    PubMed ID
    16012456
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jvs.2005.03.023
    Scopus Count
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    Population and Quantitative Health Sciences Publications

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