title: Receipt of care and reduction of lower extremity amputations in a nationally representative sample of U.S. Elderly.
abstract: OBJECTIVE
  To determine effectiveness of receipt of care from podiatrist and lower extremity clinician specialists (LEC specialists) on diabetes mellitus (DM)-related lower extremity amputation.
  
  
  METHODS
  Medicare 5 percent sample claims, 1991-2007.
  
  
  METHODS
  Individuals with DM-related lower extremity complications (LECs) were followed 6 years. Visits with podiatrists, LEC specialists, and other health professionals were tracked to ascertain whether receipt of such care reduced the hazards of an LEC amputation.
  
  
  METHODS
  Individuals were stratified based on disease severity, Stage 1--neuropathy, paresthesia, pain in feet, diabetic amyotrophy; Stage 2--cellulitis, charcot foot; Stage 3--ulcer; Stage 4--osteomyelitis, gangrene.
  
  
  RESULTS
  Half the LEC sample died within 6 years. More severe lower extremity disease increased risk of death and amputation. Persons visiting a podiatrist and an LEC specialist within a year before developing all stage complications were between 31 percent (ulceration) and 77 percent (cellulitis and charcot foot) as likely to undergo amputation compared with individuals visiting other health professionals.
  
  
  CONCLUSIONS
  Individuals with an LEC had high mortality. Visiting both a podiatrist and an LEC specialist in the year before LEC diagnosis was protective of undergoing lower extremity amputation, suggesting a benefit from multidisciplinary care.
authors: Department of Economics, Duke University, 236 Social Sciences Building, Box 90097, Durham, NC 27708, USA. fsloan@duke.edu
authors: Frank A
authors: FA
authors: Sloan
authors: Mark N
authors: MN
authors: Feinglos
authors: Daniel S
authors: DS
authors: Grossman
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D048909:Diabetes Complications / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D008511:Medicine; D011032:Podiatry; D014481:United States