459. Gaps in Diabetic Foot Care in an Inner-City Hospital
Autor: | Sierra Patterson, Marcos C. Schechter, Maya Fayfman, Guillermo E. Umpierrez, Ravi R. Rajani, David C. Ziemer, Russell R. Kempker, Lubna Smf. Khan |
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Jazyk: | angličtina |
Rok vydání: | 2019 |
Předmět: |
medicine.medical_specialty
business.industry Osteomyelitis medicine.medical_treatment Diabetic foot care medicine.disease Wound care Abstracts Infectious Diseases Diabetic foot ulcer medicine.anatomical_structure Oncology Inner city Amputation Diabetes mellitus Emergency medicine Poster Abstracts medicine Ankle business |
Zdroj: | Open Forum Infectious Diseases |
ISSN: | 2328-8957 |
Popis: | Background Diabetic foot disease is the leading cause of preventable limb loss in the United States. Care continuum models to measure gaps in care are lacking. Methods Retrospective cohort study conducted in an urban safety-net hospital in Atlanta, GA (Grady Memorial Hospital). All patients admitted between January-May 2016 with diabetes-related foot ulcer, osteomyelitis, or for lower-extremity amputation were included. A care continuum model for inpatient and post-discharge outpatient metrics was developed based on national guidelines and available diabetes care continuum models (figure). We followed patients for 12 months after initial hospital admission. Results Among 123 patients, the median age was 56 (IQR 48–64) years and most were male (67%) and black (83%) (table). Prior to hospital admission, 12% of patients had a major amputation (above ankle) and 21% had a minor amputation (below ankle). Tobacco use (34%), homelessness (29%), and no medical insurance (20%) rates were high. Few patients (28%) had hemoglobin A1c (Hb1Ac) at goal (≤7.5%) and 10% had end-stage renal disease. Regarding inpatient care metrics, 59% had a median glucose at goal on the day of discharge (≤180 gm/dL). Few patient patients had a noninvasive vascular test (13%) or received a wound offloading device (16%) during hospitalization. Regarding post-discharge outpatient metrics, 33% had wound care ≤30 days after hospitalization, 14% with tobacco use at baseline quit, and 24% had Hb1c ≤7.5%. Emergency room (ER) visits and hospital readmissions within 12 months post-discharge were common (77% and 66%, respectively). Only 54% were retained in care (≥2 clinic visits ≥90 days apart). Outcomes during 12 months after the first day of initial hospital admission were poor: 6% died, 23% had a new major amputation and 22% had a new minor amputation. Including major amputations prior to initial hospital admission, 37% of patients died or were living with a major amputation 12 months after hospitalization. Conclusion Our care continuum model demonstrated large gaps in diabetic foot care. Over a third of these patients died or were living with major limb loss and there were high rates of ER visits and hospital readmissions. Implementing measures to close gaps in care could improve outcomes. Disclosures All authors: No reported disclosures. |
Databáze: | OpenAIRE |
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