Professional Documents
Culture Documents
2012
Carlyle Begay
American Indian Health Management
Policy
Phone: (602) 206-7992
Email: cbegay@aihmp.com
Access to care:
Wounds Have a Golden Hour
From the onset of the woundIHS patients
need wound care sooner than later
30 days to prevent further breakdown,
infection, progression to amputation
Standard of Care now requires definitive
care at or before 4 weeks with the
introduction of advanced therapy to
treat the wound
DFUs that persist more than 4 weeks have 5-fold higher risk
of infection.1
Development of an infection in a foot ulcer increases the
risk for hospitalization 55.7 times and the risk for
amputation 155 times.1
Infected neuropathic ulcerations are the leading cause of
diabetes-related partial foot amputations at the Phoenix
Indian Medical Center.2
Foot ulceration is a significant risk factor for lowerDiabetes
Neuropathy
Foot Ulcer
Infection
Amputation
3
extremity amputation in Native American Indians.
1.
2.
3.
Lavery et al. Risk Factors for Foot Infections in Individuals With Diabetes. Diabetes Care. 2006;29:1288-93.
Dannels E. Neuropathic foot ulcer prevention in diabetic American Indians with hallux limitus. J Am Podiatr
Med Assoc. 1989;79:447-50.
Mayfield et al. A foot risk classification system to predict diabetic amputation in Pima Indians. Diabetes Care.
1996;19:704-9.
Consequences of Unhealed
Neuropathic Ulcers
Nearly half of all
unhealed
neuropathic
ulcers result in
at
op
r
u
Ne
r
ce
l
cU
hi
death within 5
years
Inconsistent off-loading
Lack of wound specific
supplies/advanced
therapy
Wait and see medicine
Premature discharges and
inappropriate transfers
Funding not readily
available for clinic start
up
The Solution
Shift from a cost to treat model to a cost to heal
model
Cost avoidance by early intervention (more cost
efficient to heal simple wounds) and reduction in
waste through standardization
Continue to reduce costs
Standardize dressings and treatments to optimize
results
Standardize wound care processes at multiple sites
for consistent patient care and to increase patient
access
Advanced
Treatment Modalities
Ultra-sound debridement
Negative pressure wound therapy
Growth factor therapy
Pulsed Electromagnetic wound stimulation
Living Skin Equivalent Grafts for in clinic
use
Oxygen Therapy
Initial Results
Perceived Concerns
Staffing
Clinician participation
Equipment for diagnostics
Cost of supplies and medications
The solutions to these questions have already
been found!
A Growing Epidemic
The worldwide diabetic population is expected
to grow from 171 million to 366 million by
2025
Foot complications are one of the most
common complications in diabetic patients
The lifetime risk of a diabetic foot ulcer (DFU)
is 15% to 25%
Approximately 15% of DFUs result in
amputation
1.
1.
2.
Boulton et al. The global burden of diabetic foot disease. Lancet. 2005;366:1719-24.
Lavery et al. Risk Factors for Foot Infections in Individuals With Diabetes. Diabetes Care. 2006;29:1288-93.
1.
2.
Habib AA, Brannagan TH 3rd. Therapeutic strategies for diabetic neuropathy. Curr Neurol Neurosci Rep. 2010;10:92-100.
OConnell et al. Racial Disparities in Health Status: A comparison of the morbidity among American Indian and U.S. adults
with diabetes. Diabetes Care. 2010;33:1463-70.
DFUs that persist more than 4 weeks have 5-fold higher risk of
infection.1
Diabetes
1.
2.
3.
Neuropathy
Foot Ulcer
Infection
Amputation
Lavery et al. Risk Factors for Foot Infections in Individuals With Diabetes. Diabetes Care.
2006;29:1288-93.
Dannels E. Neuropathic foot ulcer prevention in diabetic American Indians with hallux
limitus. J Am Podiatr Med Assoc. 1989;79:447-50.
Mayfield et al. A foot risk classification system to predict diabetic amputation in Pima
Indians. Diabetes Care. 1996;19:704-9.
1.
2.
Lee JS, Lu M, Lee VS, Russell D, Bahr C, Lee ET: Lower extremity amputation. Incidence, risk factors, and mortality
in the Oklahoma Indian Diabetes Study. Diabetes. 1993;42:876-82.
OConnell et al. Racial Disparities in Health Status: A comparison of the morbidity among American Indian and U.S.
adults with diabetes. Diabetes Care. 2010;33:1463-70.
Healing Neuropathic
Ulcers: Results of a Metaanalysis
Weighted Mean Healing Rates
Consensus Conference
on Diabetic Foot Wound
Care
Continuing Research:
Healing of
Diabetic Foot Ulcers After 4
Weeks
N=133
N=117
From:
59.01 days to heal
To:
34.09 days to heal
*Dermagraft
32