Treatment and patient characteristics affecting the health status of patients with peripheral arterial disease the PORTRAIT study
The following are our research questions: (Aim 1) Do PAD treatments differ by patient characteristics? (Aim 2) Is earlier, rather than later, revascularization associated with more rapid improvements in patients' health status? (Aim 3) Does treatment of PAD vary by physician and health system?...
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| Format: | eBook |
| Language: | English |
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[Washington, D.C.]
Patient-Centered Outcomes Research Institute (PCORI)
[2019], 2019
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | The following are our research questions: (Aim 1) Do PAD treatments differ by patient characteristics? (Aim 2) Is earlier, rather than later, revascularization associated with more rapid improvements in patients' health status? (Aim 3) Does treatment of PAD vary by physician and health system? (Aim 4) Are variations in care associated with differences in patients' outcomes? (Aim 5) We created educational materials to inform future PAD treatments. METHODS: PORTRAIT enrolled 797 patients with new or worsening claudication symptoms from 10 US PAD specialty clinics. Before treatment, we interviewed patients and abstracted clinical services information from their medical records. We collected health status information at 3, 6, and 12 months follow-up. RESULTS: PAD specialist referred about 1 in 5 patients for an invasive treatment but only less than 2% patients for supervised exercise therapy. Adherence to individual PAD performance measures was relatively high for antiplatelet therapy (84%) and statin use (90%). When we defined perfect care as meeting 4 quality measures of PAD care (statin therapy, antiplatelet therapy, smoking cessation, supervised exercise therapy), only 4.6% of patients received perfect care (aim 1). The magnitude of change in patients' PAD-specific health status scores was greater at 3, 6, and 12 months follow-up in patients who underwent invasive treatment vs those who did not receive invasive treatment (aim 2). Adherence to individual PAD performance measures varied considerably across enrolling PAD clinics (aim 3). Patients who had been receiving evidence-based care (a statin and antiplatelet therapy) had better health status scores at baseline and at all time points except for 12 months (Peripheral Artery Questionnaire summary scores), as compared with those who were not receiving these measures. BACKGROUND: The impact of peripheral artery disease (PAD) on patients' health status and the processes of PAD care have not been prospectively documented in patients with new or worsening claudication. OBJECTIVES: The PORTRAIT (Patient-centered Outcomes Related to TReatment Practices in Peripheral Artery Disease: Investigating Trajectories) study prospectively defined health status outcomes and then related aspects of patient care to these outcomes in patients with new-onset or worsening claudication. In phase I, we developed and tested the study's design. We are now reporting on phase II, in which we expanded the study to 10 US PAD specialty clinics. Associations between perfect care (4 quality measures) and health status outcomes were less clear (aim 4). Women and minority-race patients had consistently lower baseline and follow-up health status scores (aim 5). We created the framework for patient educational materials in collaboration with patient advisors. CONCLUSIONS: While prescription rates for the medical management of the cardiovascular risk in PAD were relatively high, supervised exercise therapy--a performance measure--was seldom prescribed. Women and minority-race patients were at risk of experiencing a lower health status level. Receiving better quality of care following PAD evaluation at baseline was associated with better health status levels at 3-month and 6-month follow-up. Educational materials will be used to share insights learned from PORTRAIT. LIMITATIONS: Findings can be generalized only to the specialist care setting; in an observational study, the potential for residual confounding and selection bias mandates cautious interpretation; further cross-validation of risk estimates derived from health status prediction models in PORTRAIT is needed |
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| Physical Description: | 1 PDF file (61 pages) illustrations |