The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #73195

Jeffrey M. Robbins, DPM, Primary and Ambulatory Care, Department of Veteran Health Affairs Central Office, Louis Stokes Cleveland VAMC, 10701 East Boulevard, Cleveland, OH 44106, 216-231-3286, Jeffrey.Robbins@med.va.gov

Preventive foot care that is well coordinated and multidisciplinary has been reported to significantly reduce diabetes-related foot complications, especially ulceration and amputation. The management constraints of these very complex patients in a busy clinical setting are difficult to organize and even more difficult to analyze. Additionally they are viewed as a strain on resources. The microsystem process has been developed to assist clinicians approaching the complicated task of managing care for a defined patient population by assessing the components of the system from the “inside out”. In this case those components include, several different health care providers, information and communication technology and equipment, and organizational structure. The assessment helps clinicians to better define and link their core processes for delivering care. It also assists them in defining the needs of their population and systematizing the patient’s entry into and path through the system so that they have a better chance of having their health care needs met. The aim of the present study was to use the microsystem model to describe screening, surveillance, and limb salvage foot care activities for diabetes-related foot care in ten Veteran Affairs (VA) Medical Centers. We hypothesized that centers providing an organized approach to diabetes-related foot care would have better communication and coordination mechanisms and lower amputation rates. Results: 12 successful microsystem attributes were identified. The lowest major amputation rate centers averaged 4.3 attributes versus 1.7 for high rate centers. Lower rate centers had multidisciplinary wound clinics and more access to urgent foot surgery.

Learning Objectives:

• Define the microsystem approach to evaluation of complex systems of care.
• Describe how such as system could be imployed to assess an amputation prevention program.

Keywords: Diabetes, Prevention

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.