Here - EWMA 2013

FREE PAPER SESSION: DIABETIC FOOT II
Free Paper Session: Diabetic Foot II
154
DO PEOPLE WITH DIABETES HAVE A GREATER RISK OF DEVELOPING ACTIVE
DIABETIC FOOT DISEASE WHEN LIVING WITHIN AN URBAN POPULATION?
Pauline Wilson 1 , Meave Corcoran 1 , Marie Louise healy 1
1 St James’ Hospital (Dublin, Ireland).
Aim: This observational study aims to collate risk stratification data for our area and
compare it to national and international data.
Introduction: It is well documented that assessing the foot of the person with diabetes
is important. Numerous authors have written about the importance of assessing
Neuropathy Status, Vascular status, taking a history and completing an examination as
part of the annual diabetes review. Following this examination an appropriate risk status
is also important to be able to ensure that the patient receives appropriate prevention
and or treatment. Data is available for individual populations globally on their relatively
risk status, however Irish data in this regard was scarce. We hypothesised that those
living in an urban area of social deprivation would be at an increased risk of developing
foot disease and have a higher risk status when compared to international trends
Methods: Building on work done within rural settings we observed the risk status of 503
patients attending an urban diabetes consultant led service for review over a 6 month
period.
Results: Results showed that patients attending this service receiving a comprehensive
foot assessment and stratification following the Scottish model were identified as 78%
Low risk, 14% moderate risk, 7% High risk and 1% active foot disease.
Conclusion: This observational study represents approximately 10% of the diabetes
population. This highlights the need to record data accurately to allow appropriate
resource allocation and compare trends nationally and internationally. This study also
shows that there is no difference between urban and rural populations in relative risk
stratification.
155
Free Paper Session: Diabetic Foot II
Readmissions of patients with Diabetes and foot ulcers after
infra-popliteal bypass surgery: attacking the problem by an
integrated case management model
Gerhard Ruemenapf 1 , Stephan Morbach 2 , Klaus Amendt 3 , Norbert Nagel 4
1 Diakonissen-Stiftungs-Krankenhaus (Speyer, Germany);
2 Marienkrankenhaus (Soest, Germany);
3 Diakonie Krankenhaus (Mannheim, Germany);
4 B.Braun (Melsungen, Germany).
Aim: DFS patients with infrapopliteal bypasses and minor amputation require long-term
wound care. Unfortunately, postoperative outpatient care is frequently inadequate. This is
especially true for Germany, where the in- and outpatient sectors are funded and
managed separately. Thus, many patients are readmitted to the hospital following
successful treatment and discharge. This has both medical and psychical implications for
patients, as well as financial implications for the hospital.
We looked at whether a clinical case management (CM) for outpatient care according to
in-hospital standards might reduce the readmission rate, length of hospital stay (LOS)
and hospital costs.
Methods: Patients with DFS, bypass surgery and minor amputations after
implementation of the CM (n = 376) were compared with a matched historic control
group (HCG; n = 190). Since standard indexes (BRASS, Barthel) were not sensitive
enough to identify patients at the highest risk of readmittance to the hospital, we
developed a specific and sensitive tripartite scoring system based on medical, nursing as
well as social subscores. Integrated trans-sectoral CM care was offered to the 116
patients (CMP) with the highest score.
Results: The readmittance rate was reduced in CMP compared to HCG (8.8 vs. 16.4 %;
p < 0.01). Although initially, the mean LOS was higher in the CMP patients, the reduction
in readmissions improved the hospital´s economic situation, e.g. by increasing the
number of patients treated by 6 %/y.
Conclusion: A hospital-based CM significantly reduces the hospital readmissions in
patients with ischemic DFS following bypass surgery, with lower hospital costs.
EWMA 2013
COPENHAGEN
15-17 May · 2013
Danish Wound
Healing Society
97