Quality improvement efforts to address racial and ethnic disparities in patients with peripheral vascular disease and chronic limb-threatening ischemia

Introduction

Racial and ethnic disparities in care have been documented among patients who present with chronic limb-threatening ischemia (CLTI), the most severe form of peripheral artery disease (PAD). This scoping review was designed to explore the different types of quality improvement (QI) initiatives that have been set up to address disparities in access to care and treatment outcomes for this vulnerable patient population.

Methods

A systematic search of the MEDLINE, Embase, and CINAHL databases was performed to identify articles that evaluated QI programs, care processes, or outcomes established to address disparities in access and treatment among non-White and ethnic minority patients with PAD and/or CLTI. This search was limited to studies published in the English language after 1990, and abstracts were screened and abstracted by the authors. The review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines for scoping reviews.

Results

Our search yielded six articles published between 1990 and 2023 that reported on QI initiatives designed to address some aspect of differential care among non-White patients with different types of PAD including CLTI. QI protocols were primarily focused on addressing disparities in the care of non-White patients with diabetic foot infections and/or adherence to guidelines for patients with CLTI. Findings from these studies identified potential for improvement through multidisciplinary care teams and algorithm-based treatment protocols that emphasize the importance of medication compliance, timely revascularization, and frequent follow-up. Nevertheless, data between studies were heterogeneous, and there were limited protocols that specifically focused on measures to mitigate differential access for non-White patients with PAD or CLTI.

Conclusions

There has been a paucity of QI initiatives and processes established to address disparities in access to care and treatment outcomes for non-White and ethnic minority patients with PAD and/or CLTI. More hospital and community-based programs are needed to improve access to vascular surgery care for this vulnerable patient population.