The process of implementing a rural VA wound care program for diabetic foot ulcer patients.
Delivering and documenting evidence-based treatment to all Department of Veterans Affairs (VA) foot ulcer patients has wide appeal. However, primary and secondary care medical centers where 52% of these patients receive care are at a disadvantage given the frequent absence of trained specialists to manage diabetic foot ulcers. A retrospective review of diabetic foot ulcer patient records and a provider survey were conducted to document the foot ulcer problem and to assess practitioner needs. Results showed of the 125 persons with foot ulcers identified through administrative data, only, 21% of diabetic foot patients were correctly coded. Chronic Care and Microsystem models were used to prepare a tailored intervention in a VA primary care medical center. The site Principal Investigators, a multidisciplinary site wound care team, and study investigators jointly implemented a diabetic foot ulcer program. Intervention components include wound care team education and training, standardized good wound care practices based on strong scientific evidence, and a wound care template embedded in the electronic medical record to facilitate data collection, clinical decision making, patient ordering, and coding. A strategy for delivering offloading pressure devices, regular case management support, and 24/7 emergency assistance also was developed. It took 9 months to implement the model. Patients were enrolled and followed for 1 year. Process and outcome evaluations are on-going.
Reiber
Gayle E
GE
VA Puget Sound Health Care System, 1100 Olive Way, Seattle, WA 98101, USA. greiber@u.washington.edu
Raugi
Gregory J
GJ
Rowberg
Donald
D
D019090:Case Management; D017719:Diabetic Foot / Q000628:therapy*; D005568:Forms and Records Control / Q000592:standards; D006284:Health Plan Implementation; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000592:standards; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000592:standards*; D019035:Rural Health Services / Q000592:standards*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D014861:Washington