Direct healthcare services cost of non‐healing diabetic foot wounds in an African origin population in Barbados

SAT-628 Risk Factors Associated with 30-Day and 90-Day Readmission in Persons with Diabetic Foot Ulcers

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1625 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Makeda Dawkins ◽

Inthuja Baskaran ◽

Stephanie Izard ◽

Mohammed Elzanaty ◽

Meng Zhang ◽

...

Keyword(s):

Glycemic Control ◽

Diabetic Foot ◽

Hemoglobin A1c ◽

Skilled Nursing Facility ◽

Prognostic Indicator ◽

Healthcare Services ◽

C Reactive Protein ◽

Nursing Facility ◽

Skilled Nursing ◽

Reactive Protein

Abstract Background Diabetic foot ulcers (DFU) are the leading cause of lower-extremity amputations among patients with diabetes (DM)1. 15% of patients with DM develop DFU, with the potential for progression to osteomyelitis or gangrene with suboptimal glycemic control. Repeated readmissions are not only a negative prognostic indicator for these patients, but also contributes to increasing healthcare costs. Areas of Uncertainty Previous studies have examined associations among demographics, comorbidities and DFU, and the value of Hemoglobin A1c (HbA1c) and C-reactive protein (CRP) as a prognostic indicator and monitoring tool for progression and regression, respectively3,4. However, no studies to date have examined medical or pharmaceutical factors contributing to 30-day and 90-day readmission. Methods A retrospective chart review was conducted examining 397 patients with type 2 diabetes readmitted for DFU between 2014 and 2019. Variables were summarized using descriptive statistics, t-tests, chi-square, and logistic regressions. Results Majority of patients were white males with a BMI over 30 and HbA1c >7%. Patients with 30-day readmission were more likely to be using anticoagulants (30.00% vs. 17.24%, p= 0.0493). Patients with 90-day readmission were more likely to be discharged home with healthcare services (55.67% vs. 39.85%, p=0.0341) or to a skilled nursing facility (7.22% vs. 6.02%, p=0.0341). Although not statistically significant, patients with both 30-day and 90-day readmissions were also more likely to have HbA1c >7, while those with a 90-day readmission had higher CRP levels. Conclusions DFU patients with suboptimal glycemic control were more likely to experience a 30-day and 90-day readmission. Predicators for readmission in this population include: anticoagulation use, discharge to a skilled nursing facility or discharge home with healthcare services. As a result, patients not on anticoagulation, as well as those discharged home without services or to rehabilitation facilities have a reduced risk of readmission. 1. Lazzarini PA, Clark D, Derhy PH. What are the major causes of lower limb amputations in a major Australian teaching hospital? The Queensland Diabetic Foot Innovation Project, 2006 – 2007. 2011;4(1):O24. doi:10.1186/1757-1146-4-S1-O24 2. Vella L, Gatt A, Formosa C. Does Baseline Hemoglobin A1c Level Predict Diabetic Foot Ulcer Outcome or Wound Healing Time? Journal of the American Podiatric Medical Association. https://www.ncbi.nlm.nih.gov/pubmed/28880596. Published July 2017. Accessed September 28, 2019. 3. King DE, Mainous AG, Buchanan TA, Pearson WS. C-Reactive Protein and Glycemic Control in Adults With Diabetes. Diabetes Care. https://care.diabetesjournals.org/content/26/5/1535. Published May 1, 2003. Accessed September 28, 2019.

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Laboratory and Pharmaceutical Data Associated With Hospital Readmission in Persons With Diabetic Foot Ulcers

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/00469580211060779 ◽

2021 ◽

Vol 58 ◽

pp. 004695802110607

Author(s):

Alyson K. Myers ◽

Makeda Dawkins ◽

Inthuja Baskaran ◽

Stephanie Izard ◽

Meng Zhang ◽

...

Keyword(s):

Health Care ◽

Home Health Care ◽

Diabetic Foot ◽

Hospital Readmission ◽

Retrospective Chart Review ◽

Healthcare Services ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Day Hospital ◽

Insulin Use

Purpose: Diabetic foot ulcers (DFUs) are a leading cause of lower extremity amputations among persons with diabetes (PWD) and a common cause of hospitalizations. This study identified demographic characteristics, lab values, and comorbidities associated with 30-day and 90-day hospital readmission in persons with DFU. Methods: A retrospective chart review at our institution examined 397 patients with type 2 diabetes admitted with DFU between January 2014 and December 2018. Variables were analyzed using descriptive statistics, t-tests, and logistic regressions. Results: None of the studied demographic, laboratory (including Hemoglobin A1c) or comorbid diseases were associated with 30-day readmission in persons with DFU. Risk factors for 90-day readmission included discharge location to home with health care (OR: 2.62, 95% CI: 1.39, 4.95), anticoagulant use (OR: 2.36, 95% CI: 1.27, 4.39), and SQ insulin use (OR: 2.08, 95% CI: 1.20, 3.61). Conclusions: None of the variables examined were associated with 30-day readmission; however, potential predictors for 90-day readmission included anticoagulation or insulin use and discharge home with healthcare services. Future studies should devise interventions to improve transition of care in patients with DFU to further assess the role of medications and home health care as a potential predictor of 90-day hospital readmission.

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The tip of the iceberg: an overview of diabetic foot disease

British Journal of Community Nursing ◽

10.12968/bjcn.2021.26.sup3.s14 ◽

2021 ◽

Vol 26 (Sup3) ◽

pp. S14-S18

Author(s):

Pauline Wilson ◽

Declan Patton

Keyword(s):

Diabetic Foot ◽

Wound Care ◽

Healthcare Services ◽

Arterial Disease ◽

Management Plan ◽

Foot Ulceration ◽

Comprehensive Management ◽

Diabetic Foot Disease ◽

Foot Disease ◽

Peripheral Arterial

Diabetic foot disease is the leading cause of lower-extremity amputation globally and imposes a significant burden for healthcare services and patients alike. The main pathology is ulceration, due to neuropathy or peripheral arterial disease. The most frequent sign is ulceration on the foot. Ulceration needs to be referred to the multidisciplinary diabetic foot team promptly for a comprehensive management plan to be developed. Delay in referral is associated with poor outcomes. Management of diabetic foot ulceration is multifaceted, including offloading, revascularisation, infection control, debridement, glycaemic control and wound care. Management plans need to be patient focused and developed collaboratively across primary and secondary care settings.

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Reimbursement and Telepractice

Perspectives on Telepractice ◽

10.1044/teles3.2.35 ◽

2013 ◽

Vol 3 (2) ◽

pp. 35-40

Author(s):

Carol Dudding

Keyword(s):

Service Delivery ◽

Healthcare Services ◽

Speech Language Pathology ◽

Delivery Method ◽

Quality Healthcare ◽

Service Delivery Models ◽

Private Lives ◽

Language Pathology ◽

Delivery Models

Whether in our professional or private lives, we are all aware of the system wide efforts to provide quality healthcare services while containing the costs. Telemedicine as a method of service delivery has expanded as a result of changes in reimbursement and service delivery models. The growth and sustainability of telehealth within speech-language pathology and audiology, like any other service, depends on the ability to be reimbursed for services provided. Currently, reimbursement for services delivered via telehealth is variable and depends on numerous factors. An understanding of these factors and a willingness to advocate for increased reimbursement can bolster the success of practitioners interested in the telehealth as a service delivery method.

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