The impact of a staged management approach to diabetes foot care in the Louisiana public hospital system.

By the beginning of 1999, a Disease Management Initiative (DMI), consisting of targeted goals for the medical management of diabetes, had been established at all Louisiana State public hospitals. Concurrently, a regional Diabetes Foot Program (DFP) utilizing a staged management approach to foot problems was established in Baton Rouge. This study compares annual rates of hospitalization for diabetes-related foot problems and diabetes-related lower extremity amputations in diabetes patients treated for foot ulceration at the Louisiana public hospitals before and after implementation of DMI and the DFP. Mean diabetes foot-related hospitalization rates were lower in 1999 (1.96 per 100 person-years) compared to 1998 (2.61 per 100 person-years) (p < 0.001). Diabetes-related lower extremity amputation rates were also lower in 1999 (0.72 per 100 person-years) compared to 1998 (1.03 per 100 person-years) (p < 0.001). The reduction in the rate of foot-related hospitalizations was greater (p < 0.001) in patients after DMI and access to the DFP (-44%) compared to the patients after DMI without access to the DFP (-15%). There was no difference in the rate of lower extremity amputations between the patients with access to the DFP compared to the patients without access to the DFP. This study supports the effectiveness of a regional based DFP, providing a staged management approach to foot ulceration, in reducing foot-related hospitalizations, but not lower extremity amputations.