Diabetes-related foot care at 10 Veterans Affairs medical centers: must do's associated with successful microsystems.
BACKGROUND
Well-coordinated interdisciplinary preventive foot care has been reported to significantly reduce diabetes-related foot ulcers, amputations, and hospitalization. However, the contribution of the specific components leading to these "successes" is not fully characterized. The microsystem conceptual framework was adapted to foot care to determine which of the microsystem success characteristics were associated with decreased major lower-limb amputation rates at 10 Veterans Affairs (VA) medical centers.


METHODS
Two-day site visits were conducted using standardized interviews at the 10 VA medical centers.


RESULTS
Six "must do's" for foot care in microsystems were correlated at > or = (-.30) with amputation rates: (1) addressing all foot care needs, (2) appropriate referrals, (3) ease in recruiting staff, (4) confidence in staff, (5) available stand alone specialized diabetic foot care services, and (6) providers attending diabetic foot care education in the past three years. Using multiple linear regression, the sum of these items described 59% of the variance (p = 0.006).


CONCLUSIONS
Clinicians and managers may want to include the must-do's in system modifications to improve foot care for people with diabetes. Many of the sites displayed exemplary features in foot care, such as providing a formal orientation to the foot care clinics.
Wrobel
James S
JS
VA North Chicago, Illinois, USA. james.wrobel@rosalindfranklin.edu
Robbins
Jeffrey M
JM
Charns
Martin P
MP
Bonacker
Kristin M
KM
Reiber
Gayle E
GE
Pogach
Leonard
L
D000671:Amputation, Surgical / Q000706:statistics & numerical data; D017719:Diabetic Foot / Q000517:prevention & control*; D006787:Hospitals, Veterans; D006801:Humans; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D010348:Patient Care Team / Q000458:organization & administration*; D016491:Peripheral Vascular Diseases / Q000517:prevention & control*