Carls Ginger S, Gibson Teresa B, Driver Vickie R, Wrobel James S, Garoufalis Matthew G, Defrancis Roy R, Wang Shaohung, Bagalman J Erin, Christina James R
Health Outcomes, Thomson Reuters, Ann Arbor, MI 48108, USA.
J Am Podiatr Med Assoc. 2011 Mar-Apr;101(2):93-115. doi: 10.7547/1010093.
We sought to examine the economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers by evaluating cost outcomes for patients with diabetic foot ulcer who did and did not receive care from a podiatric physician in the year before the onset of a foot ulcer.
We analyzed the economic value among commercially insured patients and Medicare-eligible patients with employer-sponsored supplemental medical benefits using the MarketScan Databases. The analysis consisted of two parts. In part I, we examined cost or savings per patient associated with care by podiatric physicians using propensity score matching and regression techniques; in part II, we extrapolated cost or savings to populations.
Matched and regression-adjusted results indicated that patients who visited a podiatric physician had $13,474 lower costs in commercial plans and $3,624 lower costs in Medicare plans during 2-year follow-up (P < .01 for both). A positive net present value of increasing the share of patients at risk for diabetic foot ulcer by 1% was found, with a range of $1.2 to $17.7 million for employer-sponsored plans and $1.0 to $12.7 million for Medicare plans.
These findings suggest that podiatric medical care can reduce the disease and economic burdens of diabetes.
我们试图通过评估足部溃疡发作前一年接受和未接受足病医生治疗的糖尿病足溃疡患者的成本结果，来检验足病医生提供的专业下肢医疗护理在治疗糖尿病足溃疡方面的经济价值。
我们使用MarketScan数据库分析了商业保险患者和符合医疗保险条件且有雇主赞助补充医疗福利的患者的经济价值。该分析包括两个部分。在第一部分中，我们使用倾向得分匹配和回归技术检查了与足病医生护理相关的每位患者的成本或节省情况；在第二部分中，我们将成本或节省情况外推至总体人群。
匹配和回归调整后的结果表明，在两年随访期间，就诊于足病医生的患者在商业保险计划中的成本降低了13,474美元，在医疗保险计划中的成本降低了3,624美元（两者P均<.01）。发现将糖尿病足溃疡风险患者的比例提高1%的净现值为正，雇主赞助计划的范围为120万至1770万美元，医疗保险计划的范围为100万至1270万美元。
这些发现表明，足病医疗护理可以减轻糖尿病的疾病负担和经济负担。
