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Higher rates of all-cause mortality and resource utilization during episodes-of-care for diabetic foot ulceration

Diabetes Research and Clinical PracticePetersen BJ, Linde-Zwirble WT, Tan TW, et al. | January 19, 2022

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Researchers aimed at ascertaining if higher all-cause rates of mortality and resource utilization are recorded during periods of diabetic foot ulceration. In addition, an episode-of-care model for diabetic foot ulceration has been developed and validated.

  • The Medicare Limited Data Set between 2013 and 2019 was analyzed for retrieval of data for this study.

  • Episodes-of-care were defined by clustering diabetic foot ulcer linked claims such that the longest time interval between consecutive claims in any cluster did not extend beyond a duration which was adjusted to match two characteristics of foot ulcer episodes that are well-established in the literature: healing rate at 12 weeks, and reulceration rate following healing.

  • Rates of outcomes during periods of ulceration were compared with rates immediately after healing to determine incidence ratios.

  • A minimum mean relative error of 4.2% was recorded for the episode-of-care model in the two validation criteria using a clustering duration of 7 weeks.

  • During diabetic foot ulcer episodes, there appeared 1.5 times higher likelihood of all-cause mortality and 2.8 times more likelihood of all-cause hospitalization.

  • Overall, an underappreciated association between foot ulcer episodes and all-cause resource utilization and mortality was suggested by the newly-validated episode-of-care model for diabetic foot ulcers.

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