Introduction
Diabetes-related foot complications (DRFCs) cause substantial burden at an individual and public health level. Monitoring outcomes of High Risk Foot Services is a priority in improving patient care1. Furthermore, ensuring cost-effectiveness is paramount considering limited resources. The St Vincent’s Hospital, Sydney, High Risk Foot Clinic (HRFC) was established in 2007 with a donation.
Objectives
To characterise the evolution of our HRFC since inauguration and determine its financial viability.
Methods
A retrospective audit was performed of the HRFC database from 2010-2015. Admission data from 2013-2015 financial years was acquired using Diabetes Related Group (DRG) codes with matching financial data obtained from the Activity Based Management portal. Unless stated data are mean±SD.
Results
The audit included 163 patients (65±13yrs, 75% male). Comparing 2010 with 2015, patients seen per year (23 vs 51) and visits per patient increased (1.3±0.6 vs 2.5±1.9, p=0.03). Eighty-five percent had type 2 diabetes. Diabetes duration was 19±11yrs and HbA1c 8.0±1.8%. The most common reasons for referral were foot ulceration (69%) and Charcot arthropathy (15%). Two-thirds of ulcers were neuropathic. Ulcers were complicated by soft-tissue infection in 38% and osteomyelitis in 37%.
DRG codes identified 277 admissions for lower limb ulceration, infection or amputation. Admissions via the emergency department for DRFCs were fewer in HRFC patients compared to non-HRFC patients (prevalence ratio 0.18, p=0.0001). Length of stay was shorter for toe amputation (median 3.5 [IQR 1-14] vs 13 [IQR 6-21] days, p=0.06) and ulcer (median 2 [IQR 1-9.5] vs 6 [IQR 3-10] days, p=ns). Mean cost per admission was lower by $15,600 for toe amputation and $3200 for ulcer.
Conclusions
The number and complexity of HRFC patients has increased. Beyond delivering expert care to patients, our clinic provides demonstrable cost-benefit to the local health service.