Screening for Peripheral Arterial Disease in Primary Care using QuantaFlo: A Quality Improvement Project
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Peripheral Arterial Disease , Screening , Diabetes , Cardiovascular , QuantaFlo
Background: Peripheral arterial disease (PAD) affects 8 to 18 million individuals in the United States, and, as greater than 50 percent of patients with PAD are asymptomatic, this number may be much larger. In addition to causing symptoms of claudication, PAD is associated with greater risk of cardiovascular disease and diabetic-related complications. The American College of Cardiology (ACC) and the American Heart Association (AHA) recommend screening in adults aged 65 years or older, adults 50 years or older with risk factors for atherosclerosis (i.e., diabetes, history of smoking, hypertension, hyperlipidemia) or a family history of PAD, and adults younger than 50 years with diabetes and one other risk factor for atherosclerosis. PAD screening devices, such as QuantaFlo, may be used for screening in the primary care settings to identify patients with PAD. Problem: While the ACC and AHA highly recommend screening for PAD in patients with risk factors, screening guidelines are not in place at a primary care office near a large city in Colorado, contributing to rising health costs and PAD-associated complications. Purpose/Aims: The purpose of this quality improvement project was to implement PAD screening practices in a primary care clinic with goals of educating health care providers and staff regarding screening guidelines, implementing screening practices for PAD, completing PAD screening on 60 percent of eligible patients, and identifying the percentage of screened patients with an abnormal PAD index and their associated risk factors. Methods: This quality improvement project was implemented over an eight-week period in a primary care office near a major city in Colorado. Education materials were provided regarding screening guidelines and proper use of QuantaFlo, a PAD screening device from Semler Scientific, Inc. Inclusion criteria for this project included the following: (1) aged 65 years or older, aged 50 years or older with risk factors for atherosclerosis (i.e., diabetes, history of smoking, hypertension, hyperlipidemia) or a family history of PAD, and (2) presented to the clinic for annual visits, chronic care management, or a new patient visit. Patients who were screened for PAD in the last year or with a prior diagnosis of PAD were excluded. The investigator reviewed results weekly of patients who consented to testing, and risk factors were reviewed if an abnormal result was found. Results: Twenty of 398 (5.03 percent) eligible patients were screened, and six (30 percent) of screened individuals were found to have mild disease. Of the six individuals diagnosed with PAD, one had a history of diabetes, two had history of hypertension, three had a history of smoking, four had a family history of coronary artery disease, heart attack, or stroke, and all six had a history of hyperlipidemia. Potential cost of the screening to the patient and time were reported as the most significant barriers by participating health care providers and medical assistants. Conclusion: Given the small sample size, further evaluation is needed to assess the efficacy of QuantaFlo screening for identifying patients with a diagnosis of PAD in this clinic.
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