Community Care Consultations for Veterans with Diabetic Foot Ulcers

To quantify community care consultations for patients with newly diagnosed diabetic foot ulcers (DFUs), identify associated patient- and facility-level characteristics, and measure time to specialty care within and outside the Veterans Health Administration (VHA).

A retrospective cohort study.

This study included patients 65 years and older with newly diagnosed DFUs who received specialty care between 2019 and 2023. Data were sourced from the VHA Corporate Data Warehouse and linked Medicare data. Community care consultation was defined as receiving specialized consultations (ie, podiatry, vascular surgery, infectious disease, endocrinology) at a community health care system within 1 year of DFU diagnosis. Patient demographics, comorbidities, and facility characteristics were analyzed with multivariable mixed-effects logistic regression models to assess factors associated with community care consultation while controlling for facility-level clustering.

A total of 60,121 patients with a new diagnosis of DFU were included. Of these, 29.2% had a community care consultation. Those receiving community care were more often older, White, living in a rural area, and cared for in lower-complexity facilities. Patients were more frequently referred to community care for vascular surgery, infectious disease, and endocrinology consultations than for podiatry. For all specialties, the time to a new consultation was longer for community care than for a consultation within the VHA.

Community care consultations for patients with DFUs in the VHA system were substantial but varied significantly across facilities. Rural and lower-complexity facilities relied more on community care, particularly for vascular surgery, infectious disease, and endocrinology. Future research should explore the impact of community care on DFU outcomes and strategies to enhance multidisciplinary care coordination.