Outcomes of a Nurse-Managed Diabetes Foot Clinic.

摘要

Purpose: This study measured outcomes of a nurse-managed diabetes foot clinic on foot wound rates, health care costs, and changes in health status in adults with diabetes. Design: This study reflects results of a two-group randomized, controlled trial. Sample: Participants were 126 adults with diabetes for more than 5 years and high- or very-high-risk feet. Instrumentation: Participants were randomized to control (n = 62) or treatment (n = 64) using stratified assignment by risk. All received diabetic-foot self-care education and foot assessment. Controls were seen very three months. Treatment participants with high-risk feet were seen every 3 months and those with very-high-risk feet, every 2 months. Methods: Five nurses with 90% inter-rater reliability used a standard assessment form to rate relevant foot conditions and 10-g monofilament testing for neuropathy on 10 sites on the plantar aspect of the foot. Treatment included nail clipping, callus filing, corn removal, padding, footwear selection, and special shoes as needed. Analysis: The data were analyzed using analysis of variance, chi-square, t tests, linear regression, and frequency calculations. A health care economist used a bootstrapping technique to determine costs of care during the 1-year study. Cost data were compared to Medicare reimbursement costs for related common procedure terminology (CPT) codes. Findings: A total of 74 wounds occurred in the control group and 62 in the treatment group. Change in wound prevalence was significant (p = .03). There was no effect on overall health status. Costs were higher in the treatment group by an average of $ 312 per participant. No study participants were hospitalized for foot wounds. Hospital data showed that, during the study period, 46 admissions for diabetic foot wounds occurred in nonstudy patients who received little foot care.