Just like trauma centers are classified based on resources and community needs, so too amputation prevention units are categorized. Based on many requests, we post these definitions on the ToeAndFlow blog. More of these data can be found in our recent manuscript: Rogers, et al, Journal of Vascular Surgery, 2010. We’re indebted to our long time SALSAmigo, Prof. Sir Karel Bakker for his leadership in helping to disseminate these.
Three Clinical Levels Of Diabetic Foot Care: Basic, Intermediate and Centers of Excellence
Level 3 Basic Model of Care
|
Aim |
Prevention and basic curative care |
|
Patients |
Own population |
|
Setting |
General practitioners’ office, health center or small regional hospital |
|
Potential clinicians |
–General Practitioner –Podiatrist –Diabetic Nurse
|
|
Facilitating elements |
Close collaboration with a referral center |
Level 2
Intermediate Model
|
Aim |
Prevention and curative care for all types of patients and more advanced assessment and diagnosis |
|
Patients |
From the regional catchment area of the hospital with possibly some referrals from outside the region |
|
Setting |
Hospital |
|
Potential clinicians |
–Diabetologist –Vascular surgeon –Podiatrist –Diabetic Nurse
|
|
Facilitating elements |
Motivated coordinator to inspire team Exchange experience with other centers Staff meetings to discuss diabetic foot patients Active collaboration with other departments within the hospital Active collaboration with extra-mural facilities (GP’s, nursing homes, etc) |
Level 1
Center of Excellence:
|
Aim |
Prevention and specialized curative care for complex cases To teach other centers |
|
Patients |
National, regional or even international referral centre |
|
Potential Clinicians |
–Diabetologist –Vascular surgeon –Podiatrist –Orthopaedist –Orthotist –Educator –Plaster technician –Rehabilitation specialist –Diabetic Nurse –Psychiatrist
|
|
Setting |
Usually a large teaching or university hospital |
|
Facilitating elements |
Organize regional, national or international meetings Allow providers to visit to improve knowledge and practical skills Active collaboration with other reference centers Active participation in the development of guidelines |
I think this classification scheme is needed and valuable, as it allows us all to gauge our particular institution's performance. I, for one, am trying to get my institution to the Level 1 category. Good job, Dr Rogers and team!
Janice P. Clark, DPM
we need to have a different perspective for countries like india
Arati: we agree! In fact, the Step by Step diabetic foot program got its start in India and Tanzania.