Back to 2025 Karmody Posters
Variations In Healthcare Utilization And Specialty Providers For Treatment Of Diabetic Lower Extremity Wounds In Medicare Patients Based On Race-ethnicity And Income Level
Jose Luis Lopez, Jr., MD.
University of California Los Angeles, Los Angeles, CA, USA.
OBJECTIVES: A range of healthcare professionals are involved in the diagnosis of a diabetic lower extremity (DLE) wound in patients with concomitant peripheral arterial disease (PAD). Initial wound diagnosis may play a role in care pathways, and referral patterns may impact care received by patients. This study aimed to describe DLE wound diagnosis setting and identify the specialist performing revascularization and the setting where these procedures occur.
METHODS: We identified all Medicare fee-for-service beneficiaries aged 66 and older who were diagnosed with a new DLE wound between 2017 to 2019, and 100% claims submitted for services provided during the 12 months before and after diagnosis. We used these claims to ascertain initial diagnosis, provider type, pre-existing PAD (ICD10 codes), receipt of revascularization during the 12 months following diagnosis and site of revascularization. Race/ethnicity-based comparisons were performed using Chi square and ANOVA tests.
RESULTS: 297,529 Medicare beneficiaries aged 66 and older with DLE wounds and pre-existing PAD were identified. 76.6% were White, 13.3% Black, and 7.4% Hispanic. 32.7% were low income. Most DLE wounds were initially diagnosed in office settings (51.6%), although less likely for Black and Hispanic vs. White (44.4% and 47.2% vs 54.0%, p<.001) and for low vs higher income patients (36.8% vs 58.8%, p<.001). Black and Hispanic vs White patients were more often diagnosed in the emergency room (17.9% and 16.6% vs 12.2%, p<.001) as were low vs higher income patients (15.5% vs 12.3%, p <.001). Over the 12-month post-wound diagnosis, revascularization rate was 16.8%, and primarily endovascular (85.5%). Endovascular procedures were most often performed by vascular surgeons (48.6%) and cardiologists (27.4%). Black and Hispanic patients more often had office-based endovascular procedures compared to White patients (26.2% and 36.3% vs 19.6%, p<.001). Hispanic patients were treated less often by vascular surgeons (43.0% vs 49.5%, p<.001) and more often by cardiologists and interventional radiologists (29.8% vs 27.9% and 8.4% vs 5.6%, p<.001) compared to White patients.
CONCLUSIONS: Racial minorities and low-income DLE wound patients are more likely to be diagnosed in an emergent setting, undergo endovascular interventions more often in office-based settings and, for Hispanic patients, less often by vascular surgeons. These findings may reflect varying access to specialists and care settings, or variations in practice patterns in areas with high minority populations.
Back to 2025 Karmody Posters
