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Area of Science:

  • Vascular surgery
  • Podiatry
  • Healthcare management

Background:

  • The Veterans Health Administration (VHA) initiated multidisciplinary programs in 2011 to enhance care for nonhealing foot ulcers.
  • These efforts aimed to decrease lower extremity amputation rates among veterans.

Purpose of the Study:

  • To evaluate the impact of interdisciplinary care models on amputation prevention within the VHA system.
  • To assess the effectiveness of a coordinated approach in managing complex foot conditions in veterans.

Main Methods:

  • Characterization of the VHA patient population using internal registries.
  • Comparison with sex- and zip-code matched nonveteran cohorts using Texas hospital admission data.
  • Analysis of national and local amputation frequencies and diabetes prevalence data within the VHA.

Main Results:

  • Veterans treated in VHA hospitals were older, more likely to be Black, and had higher rates of diabetes, chronic kidney disease, and heart failure compared to matched nonveterans.
  • Implementation of interdisciplinary care correlated with a 60% reduction in amputation rates (from 160 to 66 per 100,000) from 2012 to 2017.
  • The proportion of angiograms performed for foot ulcers or gangrene increased substantially from 28.9% to 90.9% during the study period.

Conclusions:

  • Interdisciplinary care is a highly effective strategy for significantly reducing leg amputation rates in the veteran population.
  • The success of this approach in amputation prevention appears independent of specific inpatient care delivery models.