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Am J Med Qual. 2011 May-Jun;26(3):193-9. doi: 10.1177/1062860610383166. Epub 2011 Feb 23.

Improving the efficiency and effectiveness of performing the diabetic foot exam.

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Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449, USA.


Microvascular complications of diabetes can result in peripheral neuropathy and impaired sensation in the feet. These issues can significantly affect morbidity and quality of life. Regular foot exams play a major role in early detection of foot problems and may help prevent amputations. An initial review found that a comprehensive diabetic foot exam (CDFE) was documented 13.5% of the time. A quality improvement effort combined provider and staff education, a standardized documentation form, an electronic reminder, and a well-defined process to improve the frequency and completeness of diabetic foot exams. After the intervention, 44.5% of CDFEs found in dictated notes lacked at least 1 component of the exam, whereas less than 4% of charts using a standardized form lacked documentation of any part of the foot exam. These efforts demonstrate the benefit of engaging providers and staff in a quality improvement initiative to increase consistency and frequency of documentation of annual CDFEs.

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