Uptake and outcomes of supervised exercise therapy for peripheral artery disease: The importance of vascular medicine specialists at a large midwestern health care system during the first 5 years of CMS reimbursement.

Autor:	Whipple MO; School of Nursing, University of Minnesota, Minneapolis, MN, USA., Burt MA; Supervised Exercise Therapy and Cardiac and Pulmonary Rehabilitation, M Health Fairview, Minneapolis, MN, USA., Pergolski AL; Supervised Exercise Therapy and Cardiac and Pulmonary Rehabilitation, M Health Fairview, Minneapolis, MN, USA., McArthur P; School of Nursing, University of Minnesota, Minneapolis, MN, USA.; School of Kinesiology, College of Education and Human Development, University of Minnesota, Minneapolis, MN, USA., Treat-Jacobson D; School of Nursing, University of Minnesota, Minneapolis, MN, USA., Salisbury DL; School of Nursing, University of Minnesota, Minneapolis, MN, USA.
Jazyk:	angličtina
Zdroj:	Vascular medicine (London, England) [Vasc Med] 2024 Apr; Vol. 29 (2), pp. 112-119. Date of Electronic Publication: 2023 Dec 12.
DOI:	10.1177/1358863X231215246
Abstrakt:	Background: Supervised exercise therapy (SET) is the cornerstone of medical therapy for symptomatic peripheral artery disease (PAD). Despite the efficacy of SET, initial reports following the 2017 Centers for Medicare and Medicaid Services (CMS) reimbursement decision indicate low SET uptake, referral, and completion. Vascular medicine specialists are key to the success of such programs. We examined rates of SET referral, completion, and outcomes in a health system with a robust SET program during the first 5 years of CMS reimbursement. Methods: A retrospective chart review of patients with PAD referred to SET between October 1, 2017 and December 31, 2022 was conducted. Patient demographic and medical characteristics, SET indication, referring provider specialty, SET participation (e.g., exercise modality, number of sessions, treadmill prescription), and outcomes were abstracted. Descriptive statistics, t -tests, and multiple linear regression were used to examine the sample, evaluate outcomes, and explore outcomes by relevant covariates (i.e., age, sex, referring provider specialty). Results: Of 5320 patients with PAD, N = 773 were referred to SET; N = 415 enrolled and were included in the present study. Vascular medicine and vascular surgery specialists were the two primary sources of referrals (30.6% and 51.6%, respectively). A total of 207 patients (49.9%) completed SET. Statistically significant and clinically meaningful improvements were observed in all outcomes. Conclusion: SET referral and completion rates are low in the 5 years following CMS reimbursement, despite the advocacy of vascular medicine specialists. SET is effective in improving patient functional capacity and quality of life. Additional efforts are needed to increase both SET availability and referrals as part of comprehensive treatment of PAD. Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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