Associations between specialty care and improved outcomes among patients with diabetic foot ulcers.
Associations between specialty care and improved outcomes among patients with diabetic foot ulcers.
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DOI：
10.1371/journal.pone.0294813
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
专科护理可以改善糖尿病足溃疡的结局。医疗服务不足的人口得到的专科护理较少。我们的目的是确定专科护理与溃疡进展、大截肢或死亡之间的关系。如果发现一种有益的关联，增加获得专科护理的机会可能有助于促进健康公平。我们回顾性分析了威斯康星州和伊利诺伊州医疗保险糖尿病足溃疡患者队列（n = 55,409），按溃疡严重程度分层（即，早期、骨髓炎或坏疽）。在每个分层中，我们构建了无事件生存期的Kaplan-Meier曲线，将事件定义为：溃疡进展、大截肢或死亡。根据患者是否接受过以下六个学科中至少一个学科的专业护理对患者进行分组：内分泌学、传染病、骨科手术、整形外科、足病学和血管外科。多变量考克斯比例风险模型估计了专科护理和无事件生存率之间的关系，调整了社会人口因素和合并症，并对溃疡严重程度进行了分层。接受专科治疗的患者与未接受专科治疗的患者相比，无事件生存期更长（所有溃疡严重程度分层的对数秩p<0.001）。调整后，与从未接受过专科护理相比，接受专科护理仍与所有溃疡严重程度的结局改善相关（早期校正风险比0.34，95% CI 0.33-0.35，p<0.001;骨髓炎aHR 0.22，95% CI 0.20-0.23，p<0.001;坏疽aHR 0.22，95%CI 0.20-0.24，p<0.001）。专科护理与糖尿病足溃疡患者较长的无事件生存期相关。增加，公平地获得专科护理可能会改善糖尿病足溃疡的结果和差异。
Specialty care may improve diabetic foot ulcer outcomes. Medically underserved populations receive less specialty care. We aimed to determine the association between specialty care and ulcer progression, major amputation, or death. If a beneficial association is found, increasing access to specialty care might help advance health equity. We retrospectively analyzed a cohort of Wisconsin and Illinois Medicare patients with diabetic foot ulcers (n = 55,409), stratified by ulcer severity (i.e., early stage, osteomyelitis, or gangrene). Within each stratum, we constructed Kaplan-Meier curves for event-free survival, defining events as: ulcer progression, major amputation, or death. Patients were grouped based on whether they received specialty care from at least one of six disciplines: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, and vascular surgery. Multivariate Cox proportional hazard models estimated the association between specialty care and event-free survival, adjusting for sociodemographic factors and comorbidities, and stratifying on ulcer severity. Patients who received specialty care had longer event-free survival compared to those who did not (log-rank p<0.001 for all ulcer severity strata). After adjusting, receipt of specialty care, compared to never, remained associated with improved outcomes for all ulcer severities (early stage adjusted hazard ratio 0.34, 95% CI 0.33–0.35, p<0.001; osteomyelitis aHR 0.22, 95% CI 0.20–0.23, p<0.001; gangrene aHR 0.22, 95% CI 0.20–0.24, p<0.001). Specialty care was associated with longer event-free survivals for patients with diabetic foot ulcers. Increased, equitable access to specialty care might improve diabetic foot ulcer outcomes and disparities.
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影响因子：
4.1
作者：
Taylor, Lindsay;Gangnon, Ronald;Powell, W. Ryan;Kramer, Joseph;Kind, Amy J. H.;Bartels, Christie M.;Brennan, Meghan B.
通讯作者：
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DOI：
10.1001/jamahealthforum.2022.3856
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期刊：
JAMA HEALTH FORUM
影响因子：
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影响因子：
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作者：
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通讯作者：
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DOI：
10.1177/106286069901400607
发表时间：
1999-11-01
期刊：
American journal of medical quality : the official journal of the American College of Medical Quality
影响因子：
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作者：
Hebert, P L;Geiss, L S;McBean, A M
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