On the go with Toe & Flow: Private Clinic Design and Flow

Lower extremity amputation secondary to diabetes and/or peripheral artery disease is a significant health issue globally. Many amputation prevention programs exist in academic settings; however, given the increasing administrative burdens associated with large institutions, it can be challenging to develop and maintain such programs in the modern era. Private amputation prevention clinics may be a viable alternative, allowing for greater control over services provided and better ability to meet patient needs. HOPE Vascular and Podiatry (https://hcic.io/), a private amputation prevention clinic established in 2023 in Houston, Texas, has successfully integrated a clinical, research, and educational program focused on amputation prevention. Key aspects of this program include a multidisciplinary team consisting of vascular/podiatric surgeons, clinical/administrative staff, and interdisciplinary collaborators. Notable advantages include decentralization of care, improvements in clinician satisfaction, and fewer administrative barriers to providing high-quality care. By identifying and quantifying the need for amputation prevention care in the community, establishing a clear mission, building a minimum viable program, and growing responsibly, there is potential to establish private amputation prevention clinics that provide high-quality, accessible, and personalized care for patients with diabetes and/or peripheral artery disease to improve limb outcomes. In this article, we describe the design and flow of HOPE Vascular and Podiatry, including how the clinic was developed, its mission and values, and ongoing clinical, research, and educational activities. We also share logistical, financial, and operational considerations, and provide lessons learned on how to effectively develop, maintain, and run a successful private amputation prevention clinic.