Diabetic foot in primary and tertiary (DEFINITE) Care: A health services innovation in coordination of diabetic foot ulcer (DFU) Care within a healthcare cluster ‐ 18‐month results from an observational population health cohort study

• Published in: International wound journal 2023-05, Vol.20 (5), p.1609-1621
• Main Authors: Lo, Zhiwen Joseph, Tan, Elaine, Chandrasekar, Sadhana, Ooi, Desmond, Liew, Huiling, Ang, Gary, Yong, Enming, Hong, Qiantai, Chew, Tiffany, Muhammad Farhan, Mohd Fadil, Zhu, Xiaoli, Ang, Pauline, Law, Chelsea, Raman, Nadiah, Park, Derek, Tavintharan, Subramaniam, Hoi, Wai Han, Lin, Jaime, Koo, Hui Yan, Choo, Julia, Low, Kai Qiang, Low, Rose, Venkataraman, Kavita, Car, Josip, Chew, Daniel EK
• Format: Article
• Language: English
• Subjects: Aged; Amputation; Cellulitis; Clinics; Cohort analysis; Cohort Studies; Collaboration; Cost control; Diabetes; Diabetes Mellitus; Diabetic Foot - surgery; diabetic foot ulcers; diabetic limb salvage; Disease prevention; Female; Foot diseases; Health care expenditures; Health Services; health services innovation; Hospitals; Humans; Leg ulcers; lower extremity amputation; Male; Mortality; multi‐disciplinary team; Original; Patients; Population; Primary care; Prospective Studies; Retrospective Studies; Review boards; Subsidies; Surveillance; Tertiary Healthcare; Wound healing
• ISSN: 1742-4801; 1742-481X; 1742-481X
• DOI: 10.1111/iwj.14016

Diabetic Foot in Primary and Tertiary (DEFINITE) Care is an inter‐institutional and multi‐disciplinary team (MDT) health systems innovation programme at a healthcare cluster in Singapore. We aim to achieve coordinated MDT care across primary and tertiary care for patients with diabetic foot ulcers (DFU), within our public healthcare cluster ‐ an integrated network of seven primary care polyclinics and two acute care tertiary hospitals (1700‐bed and 800‐bed) with a total catchment population of 2.2 million residents. Results from prospective DEFINITE Care is referenced against a retrospective 2013–2017 cohort, which was previously published. Cardiovascular profile of the study population is compared against the same population's profile in the preceding 12 months. Between June 2020 and December 2021, there were 3475 unique patients with DFU with mean age at 65.9 years, 61.2% male, mean baseline HbA1c at 8.3% with mean diabetes duration at 13.3 years, mean diabetes complication severity index (DCSI) at 5.6 and mean Charlson Comorbidity Index (CCI) at 6.8. In the 12‐months preceding enrolment to DEFINITE Care, 35.5% had surgical foot debridement, 21.2% had minor lower extremity amputation (LEA), 7.5% had major LEA whilst 16.8% had revascularisation procedures. At 18‐months after the implementation of DEFINITE Care programme, the absolute minor and major amputation rates were 8.7% (n = 302) and 5.1% (n = 176), respectively, equating to a minor and major LEA per 100000 population at 13.7 and 8.0, respectively. This represents an 80% reduction in minor amputation rates (P