Lower resource utilization for patients with healed diabetic foot ulcers during participation in a prevention program with foot temperature monitoring

• Published in: BMJ open diabetes research & care 2020-10, Vol.8 (1), p.e001440
• Main Authors: Isaac, Adam L, Swartz, Timothy D, Miller, Mark L, Short, Daniel J, Wilson, Eleanor A, Chaffo, Jamie L, Watson, Eric S, Hu, Haihong, Petersen, Brian J, Bloom, Jonathan D, Neff, Nicole J, Linders, David R, Salgado, Simon J, Locke, Jessica L, Horberg, Michael A
• Format: Article
• Language: English
• Subjects: Amputation; Clinical medicine; Diabetes; Electronic health records; Emerging Technologies, Pharmacology and Therapeutics; Enrollments; Evidence-based practice; Foot diseases; Health care; Infections; Inflammation; Informed consent; Leg ulcers; Medical equipment; Participation; Telemedicine; Trends; Working groups
• ISSN: 2052-4897; 2052-4897
• DOI: 10.1136/bmjdrc-2020-001440

IntroductionWe assessed the impact of a diabetic foot ulcer prevention program incorporating once-daily foot temperature monitoring on hospitalizations, emergency department and outpatient visits, and rates of diabetic foot ulcer recurrence and lower extremity amputations for patients with recently healed foot ulcers.Research design and methodsIn this retrospective analysis of real-world data, we enrolled 80 participants with a healed diabetic foot ulcer in a year-long foot ulcer recurrence prevention program. Four outpatient centers within a large integrated healthcare system in the USA contributed to enrollment. We evaluated diabetic foot-related outcomes and associated resource utilization for participants during three periods: the 2 years before the program, the year during the program, and after the program ended. We reported unadjusted resource utilization rates during the program and the periods before and after it. We then adjusted rates of outcomes in each phase using an interrupted time series approach, explicitly controlling for overall trends in resource utilization and recurrence during the three periods.ResultsOur unadjusted data showed high initial rates of resource utilization and recurrence before enrollment in the program, followed by lower rates during the program, and higher rates of resource utilization and similar rates of recurrence in the period following the end of the program. The adjusted data showed lower rates of hospitalizations (relative risk reduction (RRR)=0.52; number needed to treat (NNT)=3.4), lower extremity amputations (RRR=0.71; NNT=6.4), and outpatient visits (RRR=0.26; absolute risk reduction (ARR)=3.5) during the program. We also found lower rates of foot ulcer recurrence during the program in the adjusted data, particularly for wounds with infection or greater than superficial depth (RRR=0.91; NNT=4.4).ConclusionsWe observed lower rates of healthcare resource utilization for high-risk participants during enrollment in a diabetic foot prevention program incorporating once-daily foot temperature monitoring.Trial registration numberNCT04345016.