| Summary: | The new Dartmouth Atlas series on variation in the care of surgical conditions, including this report on the treatment of diabetes and peripheral arterial disease, raises new questions regarding surgical management of both common and less frequently occurring medical conditions. This report carefully details the scope of the problem of diabetes and peripheral arterial disease and, as in previous Atlas analyses, emphasizes geographic practice variation in both preventive services and in surgical treatment rates. However, the report also takes a more patient-centered view. The goals of avoiding amputation and retaining the ability to walk are paramount. The best strategies to achieve these goals are the focus of quality improvement groups such as the Vascular Quality Initiative, described in this report. The outcomes data being recorded should go a long way toward producing the kind of widely applicable data upon which patient decision support tools should be based. Patients want to know procedure and facility-based risks and benefits
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