November 08, 2006

2007 Abstracts: The Dare to C.A.R.E experience: Defining the value of extensive vascular screening and education at the local level. Results of screening over 12,000 participants at a single center.

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John D. Martin, Jon A. Hupp, Louise O. Hanson*
Anne Arundel Medical Center, Annapolis, MD

Background: Vascular screening ‘events’ have become a popular way to increase vascular awareness. Most screenings programs involve multiple sites on a single date and do not explore the local impact of screening. We evaluated the economic and community impact of the Dare-to-C.A.R.E. (DTC) program, a large, single center, continuous vascular screening and education program in Annapolis, Maryland.
Methods: Between July 2000 and July 2006, DTC was offered free to the public for those over 60 years-of-age or over 50 with risk factors. DTC consisted of a 2-hour educational lecture, completing a risk factor questionnaire, and testing blood pressure, carotid duplex, AAA ultrasound and pedal pulse / ABI determination. Results were discussed with the participants and forwarded to their primary physicians. No effort was made to self refer. Questionnaire data and screening results were analyzed and local hospital data was examined to determine the effects of screening.
Results: 12,055 screenings were performed in DTC, 439 were excluded due to age less than 40 or repeat visits, leaving 11,616 unique patients for this report. Participation grew from 189 in 2000 to over 6400 in 2005. Age ranged from 40 to 95 (Median 65 years) and females comprised 58.7 %. Demographics included Past Smokers (51.3%), Current Smokers (7.3%), Diabetes Mellitus (10.6%), Hypertension (46.7%), Hyperlipidemia (49.4%) and prior MI (11.9%). 47% of participants had evidence of at least mild disease (1-39% carotid stenosis or ABI between .7 and .9). Significant Disease (SD) (carotid stenosis >40%, AAA >3 cm, or an ABI <0.7) is displayed by age group below:

Age Group	Male	Female	Overall
>40	9.5 %	5.0 %	6.9 %
>50	9.8 %	5.1 %	7.0 %
>60	13.5 %	7.9 %	10.4 %
>70	16.2 %	9.8 %	12.6 %
>80	19.9 %	13.6 %	16.3 %

Critical Disease (CD), defined as carotid stenosis >60%, AAA > 5 cm, or an ABI <0.5 was found in 2.2% of patients. Statistical analysis showed a greater prevalence of SD and CD in patients with risk factors. Diabetes alone doubled the prevalence of disease in all age groups. Analysis of hospital procedural volume as a result of disease detected in DTC is summarized below:

Fiscal Year (does not match calendar year)	2000	2001	2002	2003	2004	2005	Total
Pts Screened	93	194	169	483	3748	4083	8770
Pts with SD	5	13	5	43	253	243	562
Vascular Cases on screened patients (excludes CTA, MRA, Vasc Lab)	0	9	20	15	106	196	346

Local hospital revenues for vascular procedures from DTC were $1,228,676. An additional 1,189 non-vascular procedures were performed on patients introduced to the hospital system via DTC and accounted for an additional $832,766 in revenue for a total of $2,061,443. Appointments for DTC are routinely booked four months in advance without public marketing indicating the effect of awareness in the community. Procedural volumes are soaring as exemplified by the growth in outpatient vascular interventions by 285% over the past 4 years.
Conclusions: The Dare-to-C.A.R.E. vascular screening and education program is an effective way to detect early and significant vascular disease. It has a powerful effect on procedural and testing volumes and revenues. Although difficult to quantify, the effect on ‘Vascular Awareness’ for patients and primary care physicians in our community is even more striking.

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