title: Reducing amputation rates in patients with diabetes at a military medical center: the limb preservation service model.
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.
  
  
  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
  The number of patients at MAMC with diagnosed diabetes increased 48% from 1999 to 2003; however, the number of LEAs decreased 82% from 33 in 1999 to 9 in 2003. Amputations of the foot, ankle, and toe comprise 71% of amputations among patients with diabetes.
  
  
  CONCLUSIONS
  The results of this study provide evidence of the value of a focused multidisciplinary foot care program for patients with diabetes. Associations between the creation of the LPS and LEA rates are discussed.
authors.affiliation: DPM, FACFAS, Madigan Army Medical Center, ATT: Department of Orthopedics, Limb Preservation Service, 9040A Fitzsimmons Ave., Tacoma, WA 98431, USA. vickie.driver@nw.amedd.army.mil
authors.forename: Vickie R
authors.initials: VR
authors.lastname: Driver
authors.forename: Jeff
authors.initials: J
authors.lastname: Madsen
authors.forename: Russell A
authors.initials: RA
authors.lastname: Goodman
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D017719:Diabetic Foot / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D023821:Limb Salvage / Q000706:statistics & numerical data*; D008887:Military Medicine / Q000458:organization & administration / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000706:statistics & numerical data; D015995:Prevalence; D015397:Program Evaluation; D012189:Retrospective Studies