TY - JOUR
T1 - Disease management for the diabetic foot
T2 - Effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations
AU - Lavery, Lawrence A.
AU - Wunderlich, Robert P.
AU - Tredwell, Jeffrey L.
PY - 2005/10/1
Y1 - 2005/10/1
N2 - Objective: To demonstrate the effectiveness of a diabetic foot disease management program in a managed care organization. Methods: We implemented a lower extremity disease management program consisting of screening and treatment protocols for diabetic members in a managed care organization. Screening consisted of evaluation of neuropathy, peripheral vascular disease, deformities, foot pressures, and history of lower extremity pathology. We stratified patients into low and high-risk groups, and implemented preventive or acute care protocols. Utilization was tracked for 28 months and compared to 12 months of historic data prior to implementation of the disease management program. Results: After we implemented the disease management program, the incidence of amputations decreased 47.4% from 12.89 per 1000 diabetics per year to 6.18 (p < 0.05). The number of foot-related hospital admissions decreased 37.8% from 22.86 per 1000 members per year to 14.23 (37.8%). The average inpatient length-of-stay (LOS) was reduced 21.7% from 4.75 to 3.72 days (p < 0.05). In addition, there was a 69.8% reduction in the number of skilled nursing facility (SNF) admissions per 1000 members per year (Table 1) and a 38.2% reduction in the average SNF LOS from 8.72 to 6.52 days (p < 0.05). Conclusion: A population-based screening and treatment program for the diabetic foot can dramatically reduce hospitalizations and clinical outcomes.
AB - Objective: To demonstrate the effectiveness of a diabetic foot disease management program in a managed care organization. Methods: We implemented a lower extremity disease management program consisting of screening and treatment protocols for diabetic members in a managed care organization. Screening consisted of evaluation of neuropathy, peripheral vascular disease, deformities, foot pressures, and history of lower extremity pathology. We stratified patients into low and high-risk groups, and implemented preventive or acute care protocols. Utilization was tracked for 28 months and compared to 12 months of historic data prior to implementation of the disease management program. Results: After we implemented the disease management program, the incidence of amputations decreased 47.4% from 12.89 per 1000 diabetics per year to 6.18 (p < 0.05). The number of foot-related hospital admissions decreased 37.8% from 22.86 per 1000 members per year to 14.23 (37.8%). The average inpatient length-of-stay (LOS) was reduced 21.7% from 4.75 to 3.72 days (p < 0.05). In addition, there was a 69.8% reduction in the number of skilled nursing facility (SNF) admissions per 1000 members per year (Table 1) and a 38.2% reduction in the average SNF LOS from 8.72 to 6.52 days (p < 0.05). Conclusion: A population-based screening and treatment program for the diabetic foot can dramatically reduce hospitalizations and clinical outcomes.
KW - Amputation
KW - Diabetes
KW - Foot
KW - Infection
KW - Prevention
KW - Ulcer
UR - http://www.scopus.com/inward/record.url?scp=23944502366&partnerID=8YFLogxK
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U2 - 10.1016/j.diabres.2005.02.010
DO - 10.1016/j.diabres.2005.02.010
M3 - Article
C2 - 16126121
AN - SCOPUS:23944502366
SN - 0168-8227
VL - 70
SP - 31
EP - 37
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
IS - 1
ER -