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Diabetes-Related LEAs: The Impact of Location

Diabetes-Related LEAs: The Impact of Location

About 80,000 lower-extremity amputations (LEAs) are performed each year on patients with diabetes in the United States. Statistical analyses have shown that the annual incidence of LEA in older patients with diabetes was 5.0 per 1,000 in 2006-2007, but decreased to 4.0 per 1,000 in 2008. “While the downward trend is encouraging, it’s important to also analyze variations in the rates of LEAs throughout the country,” says David J. Margolis, MD, PhD. Previous studies have shown that there appears to be geographic variation in the incidence of LEAs among Medicare beneficiaries with diabetes. Furthermore, about $52,000 is reimbursed annually for a Medicare beneficiary with diabetes and an LEA. “By learning more about geographic variation in LEA, we can then identify causes and develop targeted interventions for prevention,” Dr. Margolis says. Assessing Geographic Variation of LEAs In the November 2011 issue of Diabetes Care, Dr. Margolis and colleagues conducted a study to explore graphic variation of incident LEAs among Medicare beneficiaries with diabetes. The investigators performed a study of the full population of Medicare beneficiaries because it is, in essence, the largest healthcare insurance provider in the U.S. and the largest government-funded medical entitlement program. The geographic unit of analysis was hospital referral regions (HRRs). The study then evaluated the incidence of LEA by HRRs as a function of geographic location throughout the country. Other items analyzed in the study included sociodemographic factors, risk factors for LEA, diabetes severity, provider access, and cost of care. “Our findings showed that rates of amputation varied greatly according to where patients lived, but questions remain as to why this occurs,” says Dr. Margolis....
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