Important data for anyone wanting to get benchmarks for setting up a community, regional or nationwide service. Thanks to our SALSAmigos Duncan Stang and Graham Leese.
Quality improvement depends on data collection and audit of clinical services to inform clinical improvements. Various steps in the care of the diabetic foot can be used to audit a service but need defined audit standards.
A diabetes foot service should have risk stratification system in place that should compare to the population based figures of:
76% having low risk feet, 17% moderate risk and 7% being at high risk of ulceration. The “Green, Yellow and Red Light” system is listed here.
Resources can then be directed towards those with high risk feet. Prevalence of foot ulceration needs audited.
Community based studies give an audit standard of around 2% with active ulceration, with 2 to 9% having had an ulcer at some stage in the past.
Amputation rates should be easier to measure and the best results for amputation rates are reported to be around 1.5-3 per 1,000 people with diabetes. This is a useful benchmark figure and the rate has been shown to decrease by approximately a third over the last fifteen years in some centres.
Ulceration rates and ulcer healing rates are the ultimate outcome audit measure as they are always undesirable, whilst occasionally for defined individuals an amputation can be a good outcome.
In addition to clinical outcomes, processes of care can be audited such as:
a. provision of clinical services
b. time from new ulcer to be seen by health-care professional
c. in-patient foot care or use of antibiotics.
Measurement of clinical services can be a challenge in the diabetic foot, but it is essential if clinical services and patient outcomes are to be improved.