The relationship between provider coordination and diabetes-related foot outcomes.
OBJECTIVE
To investigate the relationship between provider coordination and amputations in patients with diabetes.


METHODS
The study design was a cross-sectional, descriptive study of process and outcomes for diabetes-related foot care at 10 Department of Veterans Affairs (VA) medical centers representing different geographic regions, population densities, patient populations, and amputation rates. The subjects included all providers of diabetes foot care and a random sample of primary care providers at each medical center. The main outcome measures were the Foot Systems Assessment Tool (FootSAT), nontraumatic lower extremity amputation rates, and investigators' ordinal ranking of site effectiveness based on site visits.


RESULTS
The survey response rate was 48%. Scale reliability, as measured by Cronbach's alpha, ranged from 0.73 to 0.93. The scale scores for programming coordination (i.e., electronic medical record, policies, reminders, protocols, and educational seminars) and feedback coordination (i.e., discharge planning, quality of care meetings, and curbside consultations) were negatively associated with amputation rates, suggesting centers with higher levels of coordination had lower amputation rates. Statistically significant associations were found for programming coordination with minor amputations (P = 0.02) and total amputations (P = 0.04).


CONCLUSIONS
The FootSAT demonstrated a stronger association with amputation rates than site visit rankings. Among these 10 VA facilities, those with higher levels of programming and feedback coordination had significantly lower amputation rates.
VA Medical and Regional Office Center, Department of Veterans Affairs, White River Junction, Vermont 05009, USA. james.s.wrobel@dartmouth.edu
James S
JS
Wrobel
Martin P
MP
Charns
Paula
P
Diehr
Jeffrey M
JM
Robbins
Gayle E
GE
Reiber
Kristin M
KM
Bonacker
Linda B
LB
Haas
Leonard
L
Pogach
D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D017719:Diabetic Foot / Q000601:surgery* / Q000628:therapy*; D006787:Hospitals, Veterans / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D017063:Outcome Assessment, Health Care; D011897:Random Allocation; D020379:Risk Adjustment; D014481:United States