Up to one third of people with diabetes will develop a foot ulcer. Non-healing or chronic ulcerations can lead to infection and subsequent amputation. Five-year mortality of people with chronic wounds, peripheral artery disease, and/or amputation is 50%, which exceeds most cancers. In LA County, there is a remarkable 10-fold variation in amputation rates based on zip code. Assembling a motivated and experienced interdisciplinary team dramatically improves limb salvage. We propose to conduct a 24-month study using a prospective cohort design. This will consist of six-month initial data collection at four institutions: two with a limb salvage team in place (Harbor-UCLA and Olive View) and two without a formal limb salvage team (LA County-USC and Rancho Los Amigos), evaluating all patients with diabetic foot complications requiring foot surgery or vascular intervention.

From this, we will use lessons learned from the existing programs to develop a system for rapid triage, and harmonize across the DHS System using best practices. After the initial harmonization, we will compare outcomes in the 18 months after integrating the interdisciplinary “Hot Foot” Line. We anticipate that formation of this team will have a measurable reduction in high-level amputation, hospital length of stay, resource utilization (imaging and parenteral antibiotic), time to operating room, and time to appointment in post-acute (outpatient wound healing) clinics across the system. We also anticipate using this program as a model of care not only for other interdisciplinary county teams, but to help slow the scourge of diabetes related amputation, worldwide.

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