Abstract
ABSTRACTOver the past generation, limb preservation programs and diabetic foot services have begun to proliferate within academic health science centers as well as within health-care systems in general. We describe four key components for a successful program that, developed sequentially with temporal overlap, can allow the program to scale. The first component includes establishment of a ‘hot foot line’ for urgent emergency department/inpatient referral. The second includes development of a wound-healing clinic to address outpatient care through to remission. The third component focuses on the diabetic foot in remission to maximize ulcer-free days following healing. The fourth and final component focuses on implementation of local and widespread screening clinics to identify and triage patients into appropriate therapeutic and surveillance programs for healing, remission, and primary prevention. Along with developing each of these components, we describe discrete methods to quantify success.
Highlights
The population of people affected by diabetes is rising
It is estimated that up to one third of people diagnosed with diabetes will develop a foot ulcer [2]
Non-healing or chronic ulcerations can lead to infection and subsequent amputation [3]
Summary
The population of people affected by diabetes is rising. It has increased by nearly 400% in the last generation within the USA alone [1]. These components include initiating a ‘hot foot line’, having access to or establishing a wound-healing clinic, a remission clinic, and a screening clinic In addition to these four components, a limb preservation program should monitor measurable outcomes to assess and demonstrate the validity, efficacy, and long-term outcomes of these specialized programs. Once risk levels are determined, more appropriate recommendations can be made regarding shoe-gear, insoles, orthoses, and follow-up intervals From within this clinic, referrals to the appropriate specialists can be made and care can be escalated as needed to the remission clinics (for those with history of pathology), wound-healing clinic (for active non-limb threatening injuries), or the ‘hot foot line’ (when limb threatening pathology is present). Additional data collection and analysis for the screening clinic are similar to those mentioned for the remission clinic
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