Luu Ivan Y, Hong Alexander T, Lee Ashton, Arias Juan C, Shih Chia-Ding, Armstrong David G, Tan Tze-Woei
Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
San Antonio Vein and Artery Surgery, San Antonio, TX 78207, USA.
Diabetology (Basel). 2024 Oct;5(5):491-500. doi: 10.3390/diabetology5050036. Epub 2024 Oct 10.
This study aims to examine the association between state Medicaid coverage of podiatry services and the outcomes of beneficiaries with new diabetic foot ulcers (DFUs).
Medicaid beneficiaries who developed a DFU between 2010 and 2015 were identified using the PearlDiver claims database. The states were categorized into covered states (CS) and non-covered states (NCS) based on podiatric coverage during the study period. The outcomes included major amputation, minor amputation, and hospitalization due to foot infection within 12 months of index diagnosis. Logistic regression was used to assess the association of state coverage type and outcomes, controlling for age, sex, and the Charlson Comorbidity Index (CCI).
Our study included 16,905 Medicaid beneficiaries who developed new DFUs: 14,748 in CS and 2157 in NCS. The overall major amputation rate was 2.6%. The risk of major amputation was 48% lower among Medicaid beneficiaries in CS (OR 0.52, 95% CI 0.31-0.90) than in NCS. The Medicaid beneficiaries in CS had a 24% lower risk of hospitalization for foot infection (OR 0.76, 95% CI 0.67-0.85) but had a 58% higher risk of minor amputation (OR 1.58, 95% CI 1.22-2.07) than in NCS.
Medicaid coverage of podiatry services might be associated with lower rates of major amputation and reduced risk of hospitalization for foot infection.
本研究旨在探讨州医疗补助计划对足病诊疗服务的覆盖范围与新发糖尿病足溃疡（DFU）受益人的治疗结果之间的关联。
利用PearlDiver理赔数据库识别出在2010年至2015年间出现DFU的医疗补助计划受益人。根据研究期间足部诊疗服务的覆盖情况，将各州分为覆盖州（CS）和非覆盖州（NCS）。观察指标包括在初次诊断后的12个月内进行的大截肢、小截肢以及因足部感染而住院的情况。采用逻辑回归分析评估州覆盖类型与观察指标之间的关联，并对年龄、性别和查尔森合并症指数（CCI）进行控制。
我们的研究纳入了16,905例新发DFU的医疗补助计划受益人：14,748例来自覆盖州，2157例来自非覆盖州。总体大截肢率为2.6%。覆盖州的医疗补助计划受益人进行大截肢的风险比非覆盖州低48%（比值比[OR]为0.52，95%置信区间[CI]为0.31 - 0.90）。覆盖州的医疗补助计划受益人因足部感染而住院的风险比非覆盖州低24%（OR为0.76，95% CI为0.67 - 0.85），但进行小截肢的风险比非覆盖州高58%（OR为1.58，95% CI为1.22 - 2.07）。
医疗补助计划对足病诊疗服务的覆盖可能与较低的大截肢率以及足部感染住院风险降低有关。
