Outcomes of a Nurse-Managed Diabetes Foot Clinic

PURPOSE: The purpose of this study is to measure outcomes of a Nurse-Managed Foot Clinic for patients with diabetes as compared to a control group.

RESEARCH DESIGN: This study will employ an experimental design in order to measure the impact of a nurse-managed clinic on ulceration rates, healthcare costs, and changes in health status. The intervention will include a Nurse-Managed Foot Clinic that provides and coordinates comprehensive foot care for patients with diabetes.

SETTING/SAMPLE: The target population for this study is patients with the diagnosis of diabetes for five years or more enrolled in TRICARE at Brooke Army Medical Center, Fort Sam Houston, TX. The accessible population are those 4,400 patients with diabetes currently enrolled in TRICARE that volunteer to participate in the study and are not currently enrolled in a foot care clinic in the Family Medicine Service. Of those eligible for enrollment, 250 participants with high or very high foot risk classifications will be recruited from the Internal Medicine Clinic, the Family Medicine Services Clinic, the Orthopedic Clinic, the Endocrinology Clinic, the Troop Medical Clinic, and the Brace Shop.

VARIABLES OF INTEREST: Outcomes of interest are ulceration rates, health status, and healthcare costs. The intervention (Nurse-Managed Foot Clinic) is composed of foot classification, treatment, and patient education.

DATA COLLECTION: The study will be explained and voluntary consent obtained from all participants. All participants will be asked to complete the demographic and health status survey. They will also receive patient education and a foot evaluation at this time. Next, they will be randomized into the experimental and control groups. Throughout the course of the 12-month study period, the participant will be assessed and provided therapy based on their risk and wound classification assessment. At the end of the study, all participants will have a final foot assessment and complete the health status survey. Costs will be collected from existing hospital database.

DATA ANALYSIS: Exploratory data analyses will assess distributions of the variables. The continuous dependent variables will be analyzed by multivariate analysis of covariance. Ulceration rates and amputation rates will be analyzed by logistic or Poisson regression. Rates of positive foot care outcomes will be analyzed by logistic regression.

Final report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2012113494.xhtml