Mufti Mushfiqur Rahman

Background The Vascular Quality Initiative (VQI)’s linked Medicare registry (VISION), derived CPT-based algorithms for their amputation outcomes in peripheral vascular intervention (PVI), supra-inguinal bypass (SUPRA) or infra-inguinal bypass (INFRA) modules. We examined the validity of the amputation algorithm against medical chart abstraction. Methods In VISION, major amputation was defined by CPT codes 27590, 27591, 27592, 27880, 27881, and 27882 in the PVI, SUPRA, and INFRA modules for procedures performed between 2010 and 2017 in patients ≥18 years. We compared the number of amputations at 1, 3, and 5 years following the index revascularization procedure in these modules against Yale New Haven Hospital (YNHH) and Dartmouth Hitchcock Medical Center (DHMC) YNHH-DHMC chart abstraction as the gold standard. Concordance was examined using Spearman's rank correlation (ρ) and Cohen's kappa (κ) statistic. Results Medical records of 1,189 PVI, 247 INFRA and 93 SUPRA procedures were reviewed. Concordance for the number of amputations was moderate to strong (ρ .63-.75, p<.001), as well as in major amputation (κ .56-.73, p<.001) between VISION and YNHH-DHMC chart abstraction (Table). Conclusion Concordance between the number of major amputations between VISION and YNHH-DHMC chart abstraction was relatively high, but not perfect. Further augmentation of the CPT-based algorithm may be required to improve the quality of major amputation data in VISION.

Abstract Introduction: Peripheral artery disease (PAD) is a chronic disease that requires continuous and individualized disease-management to optimize patients’ symptoms, function and quality of life. Directly capturing patient-reported outcomes (PROs) in routine practice has the potential to increase the patient-centeredness of PAD care. We designed and implemented a system to measure health status within the workflow of a vascular specialty clinic. Methods: In a large academic center, from February 2020 until March 2022, an in-person patient navigation system (Yale PRO-QI) supported by a online data collection workbench was implemented to collect the EQ-5D, Peripheral Artery Questionnaire (PAQ), and VascuQol-6 as part of the outpatient consultations for lower-extremity PAD. Completion rates by month, and domain and summary scores for each PRO were derived per clinical phenotype: new patient/pre-procedural patient, post-procedural/follow-up patient. Results: Of 1071 eligible patient visits, 841 PRO assessments (n=446 unique patients) were completed, for an overall completion rate of 78.5% (monthly completion range 56.4%-100.0%). Patients had a mean age of 70.5±10.2 years, 39.4% were female, 9.6% Hispanics, 14.6% blacks, and 74.7% whites. Of the PROs administered, only the Symptom Stability, Treatment Satisfaction, and Quality of Life subscales of the PAQ were able to discriminate between the clinical phenotypes with differences that reached the minimal clinically important difference threshold of ~10 points (Figure). Conclusions: In anticipation of measurement-based care metrics that assess quality of care benchmarks for patient-centered PAD care, our health system integrated PRO workflow had a high response rate, and was able to successfully discriminate between highly symptomatic vs. stable patients as measured by validated disease-specific PRO benchmarks for PAD treatment success.

Abstract Introduction: Multi-dimensional assessments of patient reported outcomes (PROs) are becoming increasingly important in optimizing patient-centered care for chronic conditions such as peripheral artery disease (PAD). We aimed to demonstrate the feasibility of a health system integrated workflow to incorporate mental health screenings into the outpatient PAD clinic workflow. Methods: In a large academic center, we administered three validated psychological assessments to consecutive outpatients between March 3, 2021 and July 7, 2021. Assessments were administered as part of an in-person patient navigation system (Yale PRO-QI) and was supported by online data collection. Assessments included the Patient Health Questionnaire-8 (PHQ-8) for depression, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety, and the Perceived Stress Scale-4 (PSS-4) for stress. Validated cutoffs were used to screen for depression and anxiety (> 10 = depression or anxiety, respectively) and stress (>6 = high stress). Results: There were 104 assessments collected for 98 participants with a mean age of 68.6 + 12.0 years old, 38.8% female, 86.7% White, 9.1% Black and 2.0% Asian or American Indian. The majority (72.5%) were seen for a routine follow-up visit. Two participants (2.0%) screened positive for generalized anxiety disorder. For depression, 12.2% screened positive. Almost half of all participants (47.9%) had higher levels of stress compared with a normative population. There were no statistically significant associations between the risk of positive screening and visit type. Conclusions: Measurement-based care metrics are becoming a standard best practice in routine clinical operations. Psychosocial screening instruments can be integrated in PAD outpatient care and highlight opportunities to improve integrated behavioral care pathways to provide the best care for this vulnerable population.