Development of a graded management program for patients with diabetic foot ulcers based on the triangle model: A Delphi study

Abstract

Objective

To develop a structured nursing intervention program for individuals with diabetic foot ulcers (DFU), utilizing the Triangle Chronic Disease Stratified and Graded Management Model as a core framework.

Design

A Delphi study.

Settings

The semi-structured interview and preliminary formulation were carried out within the endocrinology department of a tertiary hospital located in Anhui Province, China.

Participants

Ten endocrinologists, two specialists in wound repair, one expert in chronic illness management, one health education specialist, and one sports rehabilitation expert from China's endocrinology and wound repair surgical departments.

Methods

Potential elements for the draft were selected via literature review, and the specific content, needs, challenges, current circumstances, and barriers associated with the stratified management of patients with diabetic foot ulcers (DFU) were elucidated through interviews with 16 patients and 15 medical professionals. Following four rounds of online discussions among the research team, a correspondence questionnaire for Delphi experts was meticulously crafted using the Triangle Chronic Disease Hierarchical Management Model. The questionnaire was disseminated through email to 15 domestic experts in the field from October 2023 to March 2024. The expert positive coefficient, authority coefficients, and Kendall's concordance coefficients were employed to evaluate the dependability of the graded management program. The consultation ended when expert viewpoints aligned.

Results

A total of twenty-two literature sources were integrated, and interviews were conducted with sixteen DFU patients and fifteen medical personnel before the questionnaire was developed. The program experienced two iterations of collective evaluation and feedback. The response rate for both rounds of expert consultation reached an impressive 100 %. The coefficients of expert authority were recorded at 0.80 and 0.81, respectively. The concordance coefficients calculated by Kendall for the significance and feasibility of the items across the two consultation rounds were 0.271 and 0.183 (P < 0.001), and 0.283 and 0.237 (P < 0.001), respectively. The management program comprises 80 items, systematically classified into three distinct components: i) Organizational structure, ii) Stratification standards, and iii) Grading measures. The composition comprised three principal entries, nine subordinate entries, and sixty-eight ancillary entries.

Conclusion

Our findings suggest that the graded management program for patients with DFU demonstrates a significant degree of scientific rigor, reliability, practicality, and feasibility. This approach tackles the individualized care requirements of DFU, potentially offering a systematic, evidence-based, and practical hierarchical management framework for clinical nursing. The aim is to reduce the rates of readmission and amputation, while simultaneously improving quality of life and overall prognosis.