title: Standardising practices improves clinical diabetic foot management: the Queensland Diabetic Foot Innovation Project, 2006-09.
abstract: OBJECTIVE
  The aim of this paper is to report the clinical practice changes resulting from strategies to standardise diabetic foot clinical management in three diverse ambulatory service sites in Queensland, Australia.
  
  
  METHODS
  Multifaceted strategies were implemented in 2008, including: multidisciplinary teams, clinical pathways, clinical training, clinical indicators, and telehealth support. Prior to the intervention, none of the aforementioned strategies were used, except one site had a basic multidisciplinary team. A retrospective audit of consecutive patient records from July 2006 to June 2007 determined baseline clinical activity (n=101). A clinical pathway teleform was implemented as a clinical activity analyser in 2008 (n=327) and followed up in 2009 (n=406). Pre- and post-implementation data were analysed using Chi-square tests with a significance level set at P<0.05.
  
  
  RESULTS
  There was an improvement in surveillance of the high risk population of 34% in 2008 and 19% in 2009, and treating according to risk of 15% in 2009 (P<0.05). The documentation of all best-practice clinical activities performed improved 13-66% (P<0.03).
  
  
  CONCLUSIONS
  These findings support the use of multifaceted strategies to standardise practice and improve diabetic foot complications management in diverse ambulatory services.
authors.affiliation: Allied Health Research Collaborative, The Prince Charles Hospital, Chermside, Australia. peter_lazzarini@health.qld.gov.au
authors.forename: Peter A
authors.initials: PA
authors.lastname: Lazzarini
authors.forename: Sharon R
authors.initials: SR
authors.lastname: O'Rourke
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Russell
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Derhy
authors.forename: Maarten C
authors.initials: MC
authors.lastname: Kamp
mesh_terms: D000554:Ambulatory Care Facilities; D017719:Diabetic Foot / Q000628:therapy*; D006801:Humans; D008485:Medical Audit; D010818:Practice Patterns, Physicians' / Q000458:organization & administration* / Q000592:standards*; D011793:Queensland; D012189:Retrospective Studies