Reducing Amputation Rates in Patients With Diabetes at a Military Medical Center

Abstract

OBJECTIVE -To describe and evaluate the Limb Preservation Service (LPS), a multidisciplinary, state-of-the-art, foot care clinic for patients with diabetes at Madigan Army Medical Center (MAMC). Evaluation criteria include the overall incidence of lower-extremity amputation (LEA) and the distribution of the anatomic level of amputation between 1999 and 2003. RESEARCH DESIGN AND METHODS-This is a retrospective study of the incidence and types of LEAs performed in patients with diabetes at MAMC. Patients with diagnosed diabetes and LEA procedures were identified by ICD-9-Clinical Modification (CM) codes. Hospital and clinic characteristics that are integral to the success of the program are described. RESULTS

History of the team approach to amputation prevention: Pioneers and milestones

“…History has demonstrated that comprehensive multidisciplinary foot care programs improve the quality of care and can reduce amputation rates by 36% to 86%. [1][2][3][4][5][6][7][8][9][10][11][12] Development of distal revascularization techniques to restore pulsatile blood flow to the foot has been a major advancement in limb salvage.…”

Forecasting the Value of Podiatric Medical Care in Newly Insured Diabetic Patients During Implementation of the Affordable Care Act in California

“…6 Other researchers report that multidisciplinary podiatric medical and vascular surgery care reduced major amputations 82% and achieved limb salvage rates of 83% at 5 years. 17,18 Multidisciplinary teams involving a chronic-care model reduced amputations 47.4%, and an outpatient clinic team consisting of podiatric medicine, orthopedics, endocrinology, and nursing maintained amputation rates despite a fourfold increase in diabetic patients. 19 Podiatric physicians also aid in reducing the use of resources and costs.…”

Retrospective Cohort Study Evaluating Clinical Outcomes in Lower Extremity Ulcers Treated with a Bi-layered Bioengineered Skin Substitute (BBSS) as Compared to Standard Therapy

“…Days to achieve wound closure, mean ± std) Difference (A-C) days Treatment of chronic LEUs requires an interdisciplinary approach and often requires advanced wound therapy which can contribute to considerable health care cost [12]. Driver et al, [13] reported that costs for treating the highest grade ulcers are 8 times higher than for those treating low grade ulcers.…”