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J Diabetes Complications. 2020 Apr;34(4):107516. doi: 10.1016/j.jdiacomp.2019.107516. Epub 2020 Jan 2.

Evaluation of a comprehensive diabetic foot ulcer care quality model.

Author information

1
Emory University School of Medicine, Grady Memorial Hospital, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, United States of America. Electronic address: mcoutin@emory.edu.
2
Emory University School of Medicine, Grady Memorial Hospital, Department of Medicine, Division of Endocrinology, Metabolism, and Lipids, Atlanta, GA, United States of America.
3
Emory University School of Medicine, Atlanta, GA, United States of America.
4
Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
5
Emory University School of Medicine, Grady Memorial Hospital, Department of Surgery Division of Vascular Surgery, Atlanta, GA, United States of America.
6
Emory University School of Medicine, Grady Memorial Hospital, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, United States of America.

Abstract

AIMS:

Diabetes-related amputations are typically preceded by a diabetic foot ulcer (DFU) but models to assess the quality of care are lacking. We investigated a model to measure inpatient and outpatient quality.

METHODS:

Cohort study among adults hospitalized with a DFU to a safety-net hospital during 2016. We measured adherence to DFU-related quality metrics based on guidelines during and 12 months following hospitalization. Inpatient metrics included ankle-brachial index measurement during or 6 months prior to hospitalization, receiving diabetes education and a wound offloading device prior to discharge. Outpatient metrics included wound care ≤30 days of discharge, in addition to hemoglobin A1c (HbA1c) ≤8%, tobacco cessation, and retention in care (≥2 clinic visits ≥90 days apart) 12 months following discharge.

RESULTS:

323 patients were included. Regarding inpatient metrics, 8% had an ankle brachial index measurement, 37% received diabetes education, and 20% received offloading prior to discharge. Regarding outpatient metrics, 33% received wound care ≤30 days of discharge. Twelve months following discharge, 34% achieved a HbA1c ≤8%, 13% quit tobacco, and 52% were retained in care. Twelve-month amputation-free survival was 71%.

CONCLUSIONS:

Our model demonstrated large gaps in DFU guideline-adherent care. Implementing measures to close these gaps could prevent amputations.

Conflict of interest statement

Declaration of competing interest Guillermo Umpierrez has received research grant support to Emory University for investigator-initiated studies from Sanofi, Novo Nordisk, and Dexcom. All other authors report no conflict of interest.

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