RS01 - Exploring How Multidisciplinary Clinics May Mitigate Socioeconomic Barriers to Care for Chronic Limb-Threatening Ischemia: A Mixed-Methods Study

Objectives: Social determinants of health are known to affect CLTI outcomes. While multidisciplinary clinics can improve CLTI outcomes, their role in addressing disparities is unknown. We compared outcomes within our multidisciplinary Limb Preservation Program (LPP) to those within our traditional clinics. Our LPP is located in a minority community, providing expedited care at a single facility by a consistent team of a vascular surgeon, PA, and podiatrist within a wound center. We then explored patients' perspectives on barriers to care to see if the LPP might address them.

Methods: Patients undergoing intervention from 2014-2023 were stratified by clinic type. We collected clinical and socioeconomic variables, including Area Deprivation Index (ADI). Patient characteristics were compared using chi-square, Student’s t, or Mood’s median tests. Outcomes were compared using log-rank tests. Uni- and multi-variable Cox proportional hazards analysis was performed.

We then conducted structured interviews to understand patient-perceived barriers. Thematic analysis was performed using a Framework method.

Results: From 2014-2023, 882 patients had interventions on 1001 limbs; 19.3% of limbs were treated within the LPP. Compared to traditional clinic patients, LPP patients had more comorbidities, more distal disease, and fewer lived independently. They were more likely to be minorities, reside closer to their clinic, and have worse ADI (Table I). However, there were no differences between LPP or traditional clinic patients in time to death, major adverse limb event (MALE, Figure 1), limb loss, patency, or reintervention. Within the most deprived patient subgroup (ADI>90), traditional clinic patients had earlier patency loss and reintervention compared to LPP patients. Multivariable analysis of the entire cohort demonstrated traditional clinic structure, increasing age, CHF, and dialysis were associated with earlier death. Non-white race, male sex, increasing WIfI stage, and dialysis were associated with earlier MALE.

Ten traditional clinic patients were interviewed. Emerging themes included: difficulty understanding their disease, transportation barriers, high visit frequency, patient-physician racial discordance, and distrust of the healthcare system.

Conclusions: Our LPP patients had worse comorbidities and socioeconomic deprivation, yet had similar outcomes to healthier, less deprived non-LPP patients. Our LPP structure addresses several barriers noted by patients. Its proximity to disadvantaged patients and ability to conduct multiple appointments at a single visit may address transportation and visit frequency barriers, and our consistent team may facilitate patient education and improve trust. Including these elements in a multidisciplinary clinic and locating it in an area of need may mitigate some negative impacts of socioeconomic deprivation on CLTI outcomes.