Health Care Service and Outcomes Among an Estimated 6.7 Million Ambulatory Care Diabetic Foot Cases in the U.S

• Published in: Diabetes care Vol. 40; no. 7; pp. 936 - 942
• Main Authors: Skrepnek, Grant H, Mills, Sr, Joseph L, Lavery, Lawrence A, Armstrong, David G
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.07.2017
• Subjects: Adult; Aged; Aged, 80 and over; Ambulatory Care; Centers for Disease Control and Prevention (U.S.); Chronic conditions; Chronic Disease; Cohort Studies; Cross-Sectional Studies; Delivery of Health Care; Demographics; Demography; Diabetes; Diabetes mellitus; Diabetic Foot - therapy; Disease control; Emergency medical services; Emergency Service, Hospital; Feet; Female; Foot diseases; Generalized linear models; Health care; Health Care Surveys; Health services; Hospitalization; Humans; Inpatients; Leg ulcers; Male; Medical personnel; Middle Aged; Physicians; Research design; Risk assessment; Risk Factors; Treatment Outcome; Ulcers; United States; United States > US
• DOI: 10.2337/dc16-2189
• ISSN: 0149-5992

To evaluate ambulatory clinical cases of diabetic foot ulcers (DFUs) and diabetic foot infections (DFIs) in the U.S. from 2007 to 2013 and to assess outcomes of emergency department or inpatient (ED/IP) admission, number of clinic visits per year, and physician time spent per visit. A cross-sectional historical cohort analysis was conducted by using the nationally representative Centers for Disease Control and Prevention National Ambulatory Medical Care Survey data from 2007 to 2013, including patients age ≥18 years with diabetes and either DFIs or DFUs. Study outcomes were analyzed by using generalized linear models controlling for key demographics and chronic conditions. Across the estimated 5.6 billion ambulatory care visits between 2007 and 2013, 784.8 million involved diabetes and ∼6.7 million (0.8%) were for DFUs (0.3%) or DFIs (0.5%). Relative to other ambulatory clinical cases, multivariable analyses indicated that DFUs were associated with a 3.4 times higher odds of direct ED/IP admission (CI 1.01-11.28; = 0.049), 2.1 times higher odds of referral to another physician (CI 1.14-3.71; = 0.017), 1.9 times more visits in the past 12 months (CI 1.41-2.42; < 0.001), and 1.4 times longer time spent per visit with the physician (CI 1.03-1.87; = 0.033). DFIs were independently associated with a 6.7 times higher odds of direct ED referral or IP admission (CI 2.25-19.51; < 0.001) and 1.5 times more visits in the past 12 months (CI 1.14-1.90; = 0.003). This investigation of an estimated 6.7 million diabetic foot cases indicates markedly greater risks for both ED/IP admissions and number of outpatient visits, with DFUs also associated with a higher odds of referrals to other physicians and longer physician visit times.