Aims Despite the evidence available on the epidemiology of diabetic foot ulcers and associated complications, it is not clearhow specifc organizational aspects of health care systems can positively afect their clinical trajectory. We aim to evaluatethe impact of organizational aspects of care on lower extremity amputation rates among people with type 2 diabetes afectedby foot ulcers.Methods We conducted a systematic review of the scientifc literature published between 1999 and 2019, using the followingkey terms as search criteria: people with type 2 diabetes, diagnosed with diabetic foot ulcer, treated with specifc processesand care pathways, and LEA as primary outcome. Overall results were reported as pooled odds ratios and 95% confdenceintervals obtained using fxed and random efects models.Results A total of 57 studies were found eligible, highlighting the following arrangements: dedicated teams, care pathwaysand protocols, multidisciplinary teams, and combined interventions. Among them, seven studies qualifed for a meta-analysis.According to the random efects model, interventions including any of the four arrangements were associated with a 29%reduced risk of any type of lower extremity amputation (OR = 0.71; 95% CI 0.52–0.96). The efect was larger when focusingon major LEAs alone, leading to a 48% risk reduction (OR = 0.52; 95% CI 0.30–0.91).Conclusions Specifc organizational arrangements including multidisciplinary teams and care pathways can prevent half ofthe amputations in people with diabetes and foot ulcers. Further studies using standardized criteria are needed to investigate the cost-efectiveness to facilitate wider implementation of improved organizational arrangements. Similarly, researchshould identify specifc roadblocks to translating evidence into action. These may be structures and processes at the healthsystem level, e.g. availability of professionals with the right skillset, reimbursement mechanisms, and clear organizationalintervention implementation guidelines.
Health service organisation impact on lower extremity amputations in people with type 2 diabetes with foot ulcers: systematic review and meta-analysis
Carinci FFormal Analysis
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2021-01-01
Abstract
Aims Despite the evidence available on the epidemiology of diabetic foot ulcers and associated complications, it is not clearhow specifc organizational aspects of health care systems can positively afect their clinical trajectory. We aim to evaluatethe impact of organizational aspects of care on lower extremity amputation rates among people with type 2 diabetes afectedby foot ulcers.Methods We conducted a systematic review of the scientifc literature published between 1999 and 2019, using the followingkey terms as search criteria: people with type 2 diabetes, diagnosed with diabetic foot ulcer, treated with specifc processesand care pathways, and LEA as primary outcome. Overall results were reported as pooled odds ratios and 95% confdenceintervals obtained using fxed and random efects models.Results A total of 57 studies were found eligible, highlighting the following arrangements: dedicated teams, care pathwaysand protocols, multidisciplinary teams, and combined interventions. Among them, seven studies qualifed for a meta-analysis.According to the random efects model, interventions including any of the four arrangements were associated with a 29%reduced risk of any type of lower extremity amputation (OR = 0.71; 95% CI 0.52–0.96). The efect was larger when focusingon major LEAs alone, leading to a 48% risk reduction (OR = 0.52; 95% CI 0.30–0.91).Conclusions Specifc organizational arrangements including multidisciplinary teams and care pathways can prevent half ofthe amputations in people with diabetes and foot ulcers. Further studies using standardized criteria are needed to investigate the cost-efectiveness to facilitate wider implementation of improved organizational arrangements. Similarly, researchshould identify specifc roadblocks to translating evidence into action. These may be structures and processes at the healthsystem level, e.g. availability of professionals with the right skillset, reimbursement mechanisms, and clear organizationalintervention implementation guidelines.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
