title: Structured health care for subjects with diabetic foot ulcers results in a reduction of major amputation rates.
abstract: OBJECTIVE
  We tested the effects of structured health care for the diabetic foot in one region in Germany aiming to reduce the number of major amputations.
  
  
  METHODS
  In a prospective study we investigated patients with diabetic foot in a structured system of outpatient, in-patient and rehabilitative treatment. Subjects were recruited between January 1st, 2000 and December 31, 2007. All participants underwent a two-year follow-up. The modified University of Texas Wound Classification System (UT) was the basis for documentation and data analysis. We evaluated numbers of major amputations, rates of ulcer healing and mortality. In order to compare the effect of the structured health care program with usual care in patients with diabetic foot we evaluated the same parameters at another regional hospital without interdisciplinary care of diabetic foot (controls).
  
  
  RESULTS
  684 patients with diabetic foot and 508 controls were investigated. At discharge from hospital 28.3% (structured health care program, SHC) vs. 23.0% (controls) of all ulcers had healed completely. 51.5% (SHC) vs. 49.8% (controls) were in UT grade 1.Major amputations were performed in 32 subjects of the structured health care program group (4.7%) vs. 110 (21.7%) in controls (p<0.0001). Mortality during hospitalization was 2.5% (SHC) vs. 9.4% in controls (p<0.001).
  
  
  CONCLUSIONS
  With the structured health care program we achieved a significant reduction of major amputation rates by more than 75% as compared to standard care.
authors.affiliation: Department of Diabetes, Interdisciplinary Diabetic Foot Unit, Weisseritztal-Kliniken, Freital, Germany. diabetologie@weisseritztal-kliniken.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Weck
authors.forename: Torsten
authors.initials: T
authors.lastname: Slesaczeck
authors.forename: Hartmut
authors.initials: H
authors.lastname: Paetzold
authors.forename: Dirk
authors.initials: D
authors.lastname: Muench
authors.forename: Thomas
authors.initials: T
authors.lastname: Nanning
authors.forename: Georg
authors.initials: G
authors.lastname: von Gagern
authors.forename: Andrej
authors.initials: A
authors.lastname: Brechow
authors.forename: Ulf
authors.initials: U
authors.lastname: Dietrich
authors.forename: Mandy
authors.initials: M
authors.lastname: Holfert
authors.forename: Stefan
authors.initials: S
authors.lastname: Bornstein
authors.forename: Andreas
authors.initials: A
authors.lastname: Barthel
authors.forename: Antje
authors.initials: A
authors.lastname: Thomas
authors.forename: Carsta
authors.initials: C
authors.lastname: Koehler
authors.forename: Markolf
authors.initials: M
authors.lastname: Hanefeld
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000639:trends*; D003695:Delivery of Health Care / Q000639:trends*; D017719:Diabetic Foot / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies