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. 2019;15(6):497-502.
doi: 10.2174/1573399814666181017104818.

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

Brian M Schmidt  1 , Crystal M Holmes  1 , Wen Ye  2 , Rodica Pop-Busui  1
Affiliations

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

Brian M Schmidt et al. Curr Diabetes Rev. 2019.

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.

Keywords: Diabetic foot; amputation; debridement; electronic health records; limb salvage; podiatry..

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

Figures

Fig. (1).
Fig. (1).
Rates and counts of major and minor non-traumatic lower extremity amputation.
See this image and copyright information in PMC

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