title: Disease management for the diabetic foot: effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations.
abstract: OBJECTIVE
  To demonstrate the effectiveness of a diabetic foot disease management program in a managed care organization.
  
  
  METHODS
  We implemented a lower extremity disease management program consisting of screening and treatment protocols for diabetic members in a managed care organization. Screening consisted of evaluation of neuropathy, peripheral vascular disease, deformities, foot pressures, and history of lower extremity pathology. We stratified patients into low and high-risk groups, and implemented preventive or acute care protocols. Utilization was tracked for 28 months and compared to 12 months of historic data prior to implementation of the disease management program.
  
  
  RESULTS
  After we implemented the disease management program, the incidence of amputations decreased 47.4% from 12.89 per 1000 diabetics per year to 6.18 (p<0.05). The number of foot-related hospital admissions decreased 37.8% from 22.86 per 1000 members per year to 14.23 (37.8%). The average inpatient length-of-stay (LOS) was reduced 21.7% from 4.75 to 3.72 days (p<0.05). In addition, there was a 69.8% reduction in the number of skilled nursing facility (SNF) admissions per 1000 members per year (Table 1) and a 38.2% reduction in the average SNF LOS from 8.72 to 6.52 days (p<0.05).
  
  
  CONCLUSIONS
  A population-based screening and treatment program for the diabetic foot can dramatically reduce hospitalizations and clinical outcomes.
authors.affiliation: XLHealth Corporation, Baltimore, MD, USA; 703 Highland Spring Lane, Georgetown, TX, USA. lklavery@yahoo.com
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Lavery
authors.forename: Robert P
authors.initials: RP
authors.lastname: Wunderlich
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Tredwell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D015331:Cohort Studies; D017719:Diabetic Foot / Q000517:prevention & control*; D003929:Diabetic Neuropathies / Q000175:diagnosis; D019468:Disease Management; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D012307:Risk Factors