Address correspondence to Frank A. Sloan, Ph.D., Department of Economics, Duke University, 236 Social Sciences Building, Box 90097, Durham, NC 27708; e-mail: firstname.lastname@example.org. Mark N. Feinglos, M.D., is with the Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University, Durham, NC. Daniel S. Grossman, B.A., is with the Department of Economics, Duke University, Durham, NC.
Receipt of Care and Reduction of Lower Extremity Amputations in a Nationally Representative Sample of U.S. Elderly
Article first published online: 16 AUG 2010
© Health Research and Educational Trust
Health Services Research
Volume 45, Issue 6p1, pages 1740–1762, December 2010
How to Cite
Sloan, F. A., Feinglos, M. N. and Grossman, D. S. (2010), Receipt of Care and Reduction of Lower Extremity Amputations in a Nationally Representative Sample of U.S. Elderly. Health Services Research, 45: 1740–1762. doi: 10.1111/j.1475-6773.2010.01157.x
- Issue published online: 8 NOV 2010
- Article first published online: 16 AUG 2010
- Diabetes mellitus;
Objective. To determine effectiveness of receipt of care from podiatrist and lower extremity clinician specialists (LEC specialists) on diabetes mellitus (DM)-related lower extremity amputation.
Data Sources. Medicare 5 percent sample claims, 1991–2007.
Study Design. Individuals with DM-related lower extremity complications (LECs) were followed 6 years. Visits with podiatrists, LEC specialists, and other health professionals were tracked to ascertain whether receipt of such care reduced the hazards of an LEC amputation.
Data Collection. Individuals were stratified based on disease severity, Stage 1—neuropathy, paresthesia, pain in feet, diabetic amyotrophy; Stage 2—cellutis, charcot foot; Stage 3—ulcer; Stage 4—osteomyelitis, gangrene.
Principal Findings. Half the LEC sample died within 6 years. More severe lower extremity disease increased risk of death and amputation. Persons visiting a podiatrist and an LEC specialist within a year before developing all stage complications were between 31 percent (ulceration) and 77 percent (cellulitis and charcot foot) as likely to undergo amputation compared with individuals visiting other health professionals.
Conclusions. Individuals with an LEC had high mortality. Visiting both a podiatrist and an LEC specialist in the year before LEC diagnosis was protective of undergoing lower extremity amputation, suggesting a benefit from multidisciplinary care.