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A Tale of Two Eras: Mining Big Data from Electronic Health Records to Determine Limb Salvage Rates with Podiatry.

Citation
Schmidt, Brian M, et al. “A Tale of Two Eras: Mining Big Data from Electronic Health Records to Determine Limb Salvage Rates With Podiatry”. 2019. Current Diabetes Reviews, vol. 15, no. 6, 2019, pp. 497–502.
Center University of Michigan
Author Brian M Schmidt, Crystal M Holmes, Wen Ye, Rodica Pop-Busui
Keywords Diabetic foot, amputation, debridement, electronic health records, limb salvage, podiatry.
Abstract

AIMS/HYPOTHESIS: Diabetic foot complications remain very prevalent in the US and worldwide, and a major risk for devastating amputations. We evaluated the impact of establishing a fully integrated and specialized Podiatry service into a large tertiary academic health system to implement structured and targeted preventative foot care on limb salvage rates.

METHODS: Cross-sectional cohorts' data mining analysis was conducted of all encounters for diabetes and any foot complications between 2000-2005 and 2010-2015, preceding and after full implementation of podiatry service, respectively. The primary outcome was the change in major non-traumatic lower extremity amputations. Secondary outcomes included minor non-traumatic lower extremity amputations, other diabetic foot complications, limb salvage procedures as documented by procedural coding, and location (outpatient, inpatient, ED) of service rendered.

RESULTS: We analyzed 100 million patient encounters that met the above criteria. Compared with the initial cohort, integration of specialized podiatry services resulted in a significant decrease in the number of major amputations from 127 to 85/year (p<0.05), and halved the amputations rate from 0.004% to 0.002% (p<0.05). Rates of minor lower extremity amputations remained unchanged (p>0.10), while the rates of preventative procedures including foot ulcer debridement doubled (0.0002% to 0.0004% ; p<0.03). Diagnoses of diabetic foot complications increased significantly (p<0.05) and shifted toward the outpatient setting.

CONCLUSION: Full integration of specialized Podiatry service led to a significant decrease in major amputation rates, supporting teamwork between podiatry and diabetes health-care providers is essential to performing timely diabetic foot complications management, preventative procedures leading to limb salvage, and a shift in the care location.

Year of Publication
2019
Journal
Current diabetes reviews
Volume
15
Issue
6
Number of Pages
497-502
Date Published
12/2019
ISSN Number
1875-6417
DOI
10.2174/1573399814666181017104818
Alternate Journal
Curr Diabetes Rev
PMID
30332970
PMCID
PMC6531350
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