Grant H. Skrepnek|Joseph L. Mills|Lawrence A. Lavery|David G. Armstrong
Health Care Service and Outcomes Among an Estimated 6.7 Million Ambulatory Care Diabetic Foot Cases in the U.S.
University of Oklahoma Health Sciences Center|The University of Texas Southwestern Medical Center|Baylor College of Medicine|University of Arizona
objective evaluate ambulatory clinical cases diabetic foot ulcers dfus diabetic foot infections dfis us 2007 2013 assess outcomes emergency department inpatient edip admission number clinic visits per year physician time spent per visit research design methods crosssectional historical cohort analysis conducted using nationally representative centers disease control prevention national ambulatory medical care survey data 2007 2013 including patients age 18 years diabetes either dfis dfus study outcomes analyzed using generalized linear models controlling key demographics chronic conditions results across estimated 56 billion ambulatory care visits 2007 2013 7848 million involved diabetes 67 million 08 dfus 03 dfis 05 relative ambulatory clinical cases multivariable analyses indicated dfus associated 34 times higher odds direct edip admission ci 1011128 p 0049 21 times higher odds referral another physician ci 114371 p 0017 19 times visits past 12 months ci 141242 p amplt 0001 14 times longer time spent per visit physician ci 103187 p 0033 dfis independently associated 67 times higher odds direct ed referral ip admission ci 2251951 p amplt 0001 15 times visits past 12 months ci 114190 p 0003 conclusions investigation estimated 67 million diabetic foot cases indicates markedly greater risks edip admissions number outpatient visits dfus also associated higher odds referrals physicians longer physician visit times