Diabetic foot in primary and tertiary (DEFINITE) care: An efficacious, synergistic and cost-effective multidisciplinary team model for diabetic foot care in Singapore

IF 3.3 3区医学 Q1 PERIPHERAL VASCULAR DISEASE

Seminars in Vascular Surgery Pub Date : 2025-03-01 DOI:10.1053/j.semvascsurg.2025.01.007

Wen Zhe Leo , Lixia Ge , Sadhana Chandrasekar , Elaine Tan , Yi Bing Loh , Xiaoli Zhu , Huiling Liew , Enming Yong , Tiffany Chew , Jeremy Hoe , Chelsea Law , Jaime Lin , Jo Anne Lim , Pravin Lingam , Joseph Molina , Gary Ang , Yan Sun , Zhiwen Joseph Lo , DEFINITE (Diabetic Foot in Primary and Tertiary) Care Team

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引用次数: 0

Abstract

Diabetic foot ulcers (DFUs) and lower extremity amputations (LEAs) threaten survival and quality of life (QoL) of patients, contributing to healthcare and economic burden. Guidelines advocate for a multidisciplinary team (MDT) approach, but limited literature exists on cost-effectiveness and collaboration with primary care. We present the outcomes of the Diabetic Foot in Primary and Tertiary (DEFINITE) Care program, an MDT initiative in Singapore across primary and tertiary care. Patients with DFU from June 2020 to 2022 were enrolled. Clinical outcomes encompassed one-year minor and major LEAs, mortality and LEA-free survival rates. Healthcare utilization outcomes included number of admissions, length of stay, and primary care and hospital visits. QoL and Patient Reported Outcome Measures (PROMs) were respectively assessed using the EuroQol Five-Dimensional Questionnaire and Diabetic Foot Ulcer Scale-Short Form. Results from DEFINITE were propensity-score matched against a retrospective cohort. Cost-effectiveness analysis was performed using Markov simulation. Subgroup analyses focused on at-risk populations, including patients without access to MDT clinics or podiatry, appointment defaulters, octogenarians, patients with end-stage renal failure and different primary care locations. Total of 2,798 patients, with a mean age of 65.7 years and majority males (61.4%), were included for analysis. DEFINITE Care patients had higher minor LEA and improved LEA-free survival rates, fewer and shorter hospital admissions, and enhanced QoL and PROMs. DEFINITE Care demonstrated greater cost-effectiveness when compared to traditional care. Outcomes varied among subgroups. DEFINITE Care is an efficacious and cost-effective MDT model which fosters collaboration between primary and tertiary care for diabetic limb salvage.

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糖尿病足在初级和三级（明确）护理：一个有效的，协同的和具有成本效益的多学科团队模式糖尿病足护理在新加坡

糖尿病足溃疡（DFUs）和下肢截肢（LEAs）威胁患者的生存和生活质量（QoL），造成医疗保健和经济负担。指南提倡多学科团队（MDT）方法，但关于成本效益和与初级保健合作的文献有限。我们介绍了糖尿病足初级和三级（DEFINITE）护理项目的结果，这是新加坡初级和三级护理的MDT倡议。纳入了2020年6月至2022年的DFU患者。临床结果包括一年轻微和主要LEAs、死亡率和无LEAs生存率。医疗保健利用结果包括入院次数、住院时间、初级保健和医院就诊次数。使用EuroQol五维问卷和糖尿病足溃疡量表-短表分别评估生活质量和患者报告的结果测量（PROMs）。来自DEFINITE结果与回顾性队列的倾向评分相匹配。采用马尔可夫模拟进行成本-效果分析。亚组分析侧重于高危人群，包括无法获得MDT诊所或足部治疗的患者、预约不履行者、80多岁老人、终末期肾衰竭患者和不同初级保健地点的患者。共纳入2798例患者，平均年龄65.7岁，多数为男性（61.4%）。明确护理患者有更高的轻微LEA和改善的无LEA生存率，更少和更短的住院时间，改善的生活质量和PROMs。与传统护理相比，明确护理显示出更高的成本效益。亚组间结果不同。明确护理是一种有效和具有成本效益的MDT模式，促进糖尿病肢体抢救的初级和三级护理之间的合作。

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来源期刊

Seminars in Vascular Surgery 医学-外科

CiteScore

3.50

自引率

4.00%

发文量

审稿时长

50 days

期刊介绍： Each issue of Seminars in Vascular Surgery examines the latest thinking on a particular clinical problem and features new diagnostic and operative techniques. The journal allows practitioners to expand their capabilities and to keep pace with the most rapidly evolving areas of surgery.