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Health Serv Res. 2010 Dec;45(6 Pt 1):1740-62. doi: 10.1111/j.1475-6773.2010.01157.x. Epub 2010 Aug 16.

Receipt of care and reduction of lower extremity amputations in a nationally representative sample of U.S. Elderly.

Author information

1
Department of Economics, Duke University, 236 Social Sciences Building, Box 90097, Durham, NC 27708, USA. fsloan@duke.edu

Abstract

OBJECTIVE:

To determine effectiveness of receipt of care from podiatrist and lower extremity clinician specialists (LEC specialists) on diabetes mellitus (DM)-related lower extremity amputation.

DATA SOURCES:

Medicare 5 percent sample claims, 1991-2007.

STUDY DESIGN:

Individuals with DM-related lower extremity complications (LECs) were followed 6 years. Visits with podiatrists, LEC specialists, and other health professionals were tracked to ascertain whether receipt of such care reduced the hazards of an LEC amputation.

DATA COLLECTION:

Individuals were stratified based on disease severity, Stage 1--neuropathy, paresthesia, pain in feet, diabetic amyotrophy; Stage 2--cellulitis, charcot foot; Stage 3--ulcer; Stage 4--osteomyelitis, gangrene.

PRINCIPAL FINDINGS:

Half the LEC sample died within 6 years. More severe lower extremity disease increased risk of death and amputation. Persons visiting a podiatrist and an LEC specialist within a year before developing all stage complications were between 31 percent (ulceration) and 77 percent (cellulitis and charcot foot) as likely to undergo amputation compared with individuals visiting other health professionals.

CONCLUSIONS:

Individuals with an LEC had high mortality. Visiting both a podiatrist and an LEC specialist in the year before LEC diagnosis was protective of undergoing lower extremity amputation, suggesting a benefit from multidisciplinary care.

PMID:
20722748
PMCID:
PMC3026956
DOI:
10.1111/j.1475-6773.2010.01157.x
[Indexed for MEDLINE]
Free PMC Article
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