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Optimization of Diabetic Foot Ulcer Care: A Standardized System-Wide Outpatient Clinical Care Pathway
Lucas A. Dvoracek, Joan Nilson, Steven Strong, Dominic J. Barnabei, Elizabeth Shumaker, Efthymios Avgerinos, Neel Shah, John Viehman, Macalus Hogan, Mary Korytkowski, Alex Catalano, Christopher Lamperski, J. Peter Rubin
University of Pittsburgh
2019-02-12
Presenter: Lucas Dvoracek
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background:
Outpatient wound care is complex but critical to restoring quality of life in affected patients. Many independent factors must be addressed to enable wound healing, and practice patterns vary widely by type of wound and between centers. Our goal was to create a standardized, evidence-based, and value-conscious clinical care pathway for the treatment of diabetic foot ulcers (DFU) in all UPMC outpatient wound care centers.
Methods:
A systematic review of literature published within the last 7 years regarding DFU care was conducted. All documents were evaluated for level of evidence according to the American Society of Plastic Surgeons guidelines and graded as per the US Preventative Services Task Force Grade Definitions. A flowchart of highly-graded diagnostic and therapeutic methods was constructed in conjunction with specialists from 4 fields as well as members of UPMC Health Plan administration.
Results:
164 sources were identified for evaluation. The Clinical Care Pathway flowchart addresses topics including: Wound Assessment, Infection, Perfusion, Neuropathy, Medical Comorbidity, Lifestyle, Initial and Refractory Wound Therapy, Pressure Relief, and Care Needs. The Pathway will be adapted for EPIC and implemented in all UPMC outpatient wound care centers.
Conclusions:
A standardized, evidence-based clinical care pathway for DFU may enable optimization of care, accelerated healing, and cost-savings. This model may also be adapted for guiding care in other wound types. Integration with the electronic medical record will enable detailed study of treatment efficacy and identification of new opportunities to improve patient care.
