Increased odds of direct ER referral, inpatient admission for diabetic foot ulcers, infections

Diabetic foot ulcers (DFUs) and diabetic foot infections (DFIs) are associated with increased risks of admission and outpatient visits, according to a study published online May 11 in Diabetes Care.
 
Grant H. Skrepnek, Ph.D., from the University of Oklahoma Health Sciences Center in Oklahoma City, and colleagues conducted a cross-sectional historical cohort analysis using the nationally representative U.S. Centers for Disease Control and Prevention National Ambulatory Medical Care Survey data from 2007 to 2013. Data were included for patients age ≥18 years with diabetes and either DFIs and DFUs.
 
The researchers found that about 6.7 million (0.8 percent) of the estimated 5.6 billion ambulatory care visits were for DFUs and DFIs (0.3 and 0.5 percent, respectively).
 
Relative to other ambulatory clinical cases, DFUs correlated with 3.4-fold increased odds of direct emergency department referral or inpatient admission, 2.1-fold increased odds of referral to another physician, 1.9-fold more visits in the past 12 months, and 1.4-fold longer time spend per visit with the physician, in multivariate analyses. For DFIs there were independent associations with 6.7-fold increased odds of direct emergency department referral or inpatient admission, and 1.5-fold more visits in the past 12 months.
 
"This investigation of an estimated 6.7 million diabetic foot cases indicates markedly greater risks for both ED/IP admissions and number of outpatient visits," the authors write.
 
 
Abstract
 
Health Care Service and Outcomes Among an Estimated 6.7 Million Ambulatory Care Diabetic Foot Cases in the U.S.
Grant H. Skrepnek, Joseph L. Mills Sr., Lawrence A. Lavery and David G. Armstrong
Diabetes Care 2017 May; dc162189. https://doi.org/10.2337/dc16-2189
 
OBJECTIVE 
To evaluate ambulatory clinical cases of diabetic foot ulcers (DFUs) and diabetic foot infections (DFIs) in the U.S. from 2007 to 2013 and to assess outcomes of emergency department or inpatient (ED/IP) admission, number of clinic visits per year, and physician time spent per visit.
 
RESEARCH DESIGN AND METHODS 
A cross-sectional historical cohort analysis was conducted by using the nationally representative Centers for Disease Control and Prevention National Ambulatory Medical Care Survey data from 2007 to 2013, including patients age ≥18 years with diabetes and either DFIs or DFUs. Study outcomes were analyzed by using generalized linear models controlling for key demographics and chronic conditions.
 
RESULTS 
Across the estimated 5.6 billion ambulatory care visits between 2007 and 2013, 784.8 million involved diabetes and ∼6.7 million (0.8%) were for DFUs (0.3%) or DFIs (0.5%). Relative to other ambulatory clinical cases, multivariable analyses indicated that DFUs were associated with a 3.4 times higher odds of direct ED/IP admission (CI 1.01–11.28; P = 0.049), 2.1 times higher odds of referral to another physician (CI 1.14–3.71; P = 0.017), 1.9 times more visits in the past 12 months (CI 1.41–2.42; P < 0.001), and 1.4 times longer time spent per visit with the physician (CI 1.03–1.87; P = 0.033). DFIs were independently associated with a 6.7 times higher odds of direct ED referral or IP admission (CI 2.25–19.51; P < 0.001) and 1.5 times more visits in the past 12 months (CI 1.14–1.90; P = 0.003).
 
CONCLUSIONS 
This investigation of an estimated 6.7 million diabetic foot cases indicates markedly greater risks for both ED/IP admissions and number of outpatient visits, with DFUs also associated with a higher odds of referrals to other physicians and longer physician visit times.
 
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