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Hospital educates patients on dangers of PAD

Hospital educates patients on dangers of PAD

After reading this article, you will be able to:

  • Define PAD
  • Discuss how to identify patients who would most likely benefit from PAD screening

Hospitals look for ways to improve patient education all the time. Once in a while, this education pays dividends on multiple levels—as in the case of Parrish Medical Center in Titusville, FL, where an education program on peripheral arterial disease (PAD) not only showed that a significant portion of the facility’s constituency had PAD, but also increased downstream revenue by nearly $500,000. 

The program’s original intent was to raise community awareness, standardize treatment, document outcome measures, and increase communication among those working with Parrish who provided care for PAD patients. 

Nurse educator Marialice Knight, RN, BSN, started the program at Parrish. 

“In 2003 ... I became aware of the PARTNERS study, which performed ankle-brachial indexes [ABI] on close to 7,000 patients,” says Knight. “They found that 29% were positive for peripheral arterial disease. It was interesting that less than half of their physicians were aware their patients had PAD.” 

Knight presented this study to the medical director physicians for the cardiac and pulmonary rehabilitation departments. They presented a proposal to the organization’s administration to develop a PAD network as an essential component for its full-service cardiovascular program.  

“Our administration immediately embraced it—not just as a community effort, but as a way of identifying these patients who were out there and had no idea” they were at risk, says Knight. 

The Jess Parrish Medical Foundation purchased 20 ABI machines and recruited physicians to place the screening devices in their offices. Extensive training programs were also implemented. 

“We realized we weren’t getting the volumes we wanted, so we expanded the program,” says Knight. 

Every September between 2005 and 2007, the organization hosted free screenings. 

In 2007, the effort kicked into overdrive, and Knight and her associates began gathering data in conjunction with the HeartCaring Program with Spirit Health Group. 

“That’s where we are today—since May 2007, we’ve done more than 1,700 screenings,” says Knight. 

The program has evolved over time. The initial case study involved 883 patients who heard about the study through advertisements calling for specific risk factors. Since the initial study, the program has been revised to target diabetics, smokers, hypertensives, people with high cholesterol, and people with vascular disease. 

“As a result, at this point our numbers [of screenings] are less, but we’re screening the people most at risk,” says Knight. 

Targeting the right people required the help of the communication and service excellence department through press releases calling for individuals with specific risk factors.

“I’ve gone to the diabetes program, the cardiac/pulmonary rehab center, the sleep lab, [and more]. The clinicians were informed of the risk factors, signs, and symptoms of PAD patients,” says Knight. The clinicians would prescreen the patients and refer them to the free screenings.

The PAD program has also been a contributing factor in the organization’s Joint Commission disease-specific certifications for acute coronary syndrome, stroke, heart failure, and diabetes.

“Eventually physicians began sending patients for free ABIs, and it evolved to the point where the community trusts the program,” says Knight.  

Knight recommends reaching out to all of your support groups, including stroke, cardiac, and diabetes, and invite all of these groups to your free screenings. 

“These are the people who could be at risk, and their caregivers,” says Knight.


Parrish worked to educate not only the patients in the hospital, but also prospective patients in the community. Information was published both internally and in the local media, but perhaps more importantly, Knight gave roughly 50 lectures in the community on the disease. 

“We don’t rush our screenings,” says Knight. Each client has a full 30 minutes for the screening with a healthcare provider. 

“The reason is that they might come up positive,” she says. “We give them the results right there, and if their screening is positive for PAD, we thoroughly explain their results, educate them, and refer them back to their physician for follow-up care.”

“This has really worked out well,” Knight continues. “Our physicians treat these patients with lower-extremity PAD by achieving risk reduction and specific treatment targets comparable to those individuals with established coronary artery disease.” 


To evaluate the outcomes of the PAD program, a revenue report was generated using internal procedure codes. Tracking of procedures and charges was performed by the organization’s information systems and finance departments.  

Managers in the cardiovascular and diagnostic imaging departments submitted their diagnostic codes to Knight.

Of the 261 patients positive for PAD, procedures were tracked for 96 individuals.

The collaborative effort proved to enhance relationships with Parrish physicians and increased cardiovascular and diagnostic service volumes. 

Because of the program, the organization saw an increase in downstream revenue. Many of the patients who came in for free screenings returned to the hospital for additional tests as repeat patients. 

But the true reason to continue such a program is its undeniable benefit to patient health. 

“Patients were identified with cardiovascular disease and/or PAD and received diagnostics and interventions at Parrish Medical Center, thereby preventing outmigration of cardiovascular and diagnostic imaging services,” says Knight. 

Although additional revenue is beneficial to the hospital, the real reasons for the screening program are to raise awareness, provide detection and standardization of treatment for PAD, and to benefit the health of the community. 

“It’s the right thing to do. We are finding these people at risk and preventing a cardiovascular episode such as heart attack or stroke,” says Knight. “The ABI test is like a window into the vascular system. Some call it the ‘EKG of the legs.’ ”

What is PAD?

Peripheral arterial disease (PAD) is a medical condition caused by blockages of the arteries that provide blood flow to the arms or legs. In the United States, the American Heart Association estimates that 8 million–12 million people are affected by this disease. It strikes most commonly among the over-50 population—one person in 20. 

Patients are evaluated for PAD through the use of an ankle-brachial index (ABI). PAD is considered present if the ABI is 0.90 or less. 

Among patients who present with lower-extremity PAD, roughly one-third to one-half show signs of coronary artery disease based on clinical history and electrocardogram, and two-thirds based on a stress test. Significant coronary artery disease of at least one coronary artery has been reported in up to 60% to 80% of those with lower-extremity PAD.