Pilot study to assess measures to be used in the prospective audit of the management of foot ulcers in people with diabetes

AimTo design and test a methodology for assessing aspects of the management of foot disease in diabetes. MethodsA national working group devised pilot datasets that may be used to document the process of management of active ulceration. Participating volunteer specialist units throughout England were required to characterize newly presenting people with diabetic foot ulcers using a standard questionnaire comprising the dataset and to document outcomes at 6 and 12 months. Semi-structured interviews were later conducted with the volunteers at the units. ResultsA total of 23 units recorded baseline data on 652 people with incident foot ulcers; valid outcome data were available for 541 people (83.0%). Of the 541 index ulcers, 351 (64.9%) healed within 24 weeks, with a median time to healing of 63 days. Ulcer site and depth and peripheral arterial disease were associated with differing ulcer healing rates. By contrast, baseline demographic characteristics were not independently associated with healing. These were used to calculate a standardized case-mix adjusted healing ratio. In most units data collection took <10 min per person, but participants reported that the burden of local data collection was still excessive. ConclusionThis study confirmed the feasibility of routine multi-unit comparative assessment of care of the foot in diabetes, including the generation of meaningful service reports, but for general use the burden of local data collection will need to be reduced (e.g. by using linkage to existing national data collections). What's new? <list list-type="bulleted" id="dme12564-list-0102"> This study tested a methodology for the measurement of processes and outcomes in the management of diabetic foot ulcers. It provides the foundation for the first national audit of foot care within the National Diabetes Audit that will produce case-mix standardized measures for comparison of outcomes between specialist units. Half (49.4%) of ulcers healed within 12 weeks. Having an ulcer on the hind foot, involving muscle, tendon or deeper tissue, and having evidence of peripheral arterial disease were associated with a lower chance of the ulcer healing within 12 and 24 weeks of initial presentation to the specialist team. There was no association between demographic characteristics (ages, sex, ethnic group, deprivation) and the likelihood of early ulcer healing.