[A MODEL TO SOLVE BARRIERS IN TREATING COMPLEX MEDICAL PATIENTS - 'DIABETIC FOOT' AS A CASE STUDY]

To identify barriers for diabetic foot detection within the medical team, to plan and conduct interventions to solve these barriers and to follow-up their outcomes, resulting in creating a model to cope with barriers in the treatment of complicated patients.

Diabetes mellitus is a rising epidemic worldwide, with a significant medical and economic impact (about 20% of the annual health expenditure). A major complication of diabetes is 'diabetic foot', including neuropathy and peripheral vascular disease, resulting in leg ulcers and amputation. Morbidity and mortality in amputated patients are significantly higher, while in 85% of the patients, a preventable leg ulcer could be detected prior to amputation. Screening and patient education may reduce leg ulcers and amputation by 45%.

Identify barriers and solutions, ranking their relative weight and correlation matrix, by a focus group.

Identifying the relative weight of the barriers, revealed that professional barriers were dominant, followed by policy, administrative and educational barriers.

Identifying barriers and their solutions in the measuring process of quality medical indices, may improve the scope and quality of the measurement, as well as affect health outcomes. A model for detecting barriers increased the involvement of staff to improve processes and promote interdisciplinary communication. It is recommended to intensify the engagement in resolving barriers as part of the quality improvement processes.

Identifying barriers is a crucial step for their removal. Adjusting optimized solutions, setting a clear policy, guidance and the cooperation of a multidisciplinary team, defining "diabetic foot assessment tool" as a required "quality index", and conducting periodic controls of the implementation of this standard, enhance the translation of policy to feasible activity measures.