The U.S. Department of Veterans Affairs (VA) Office of Inspector General (OIG) Office of Healthcare Inspections (OHI) released a study on January 17 that assessed whether patients with diabetes mellitus and additional risk factors for lower-limb amputation received annual foot care in accordance with Veterans Health Administration (VHA) requirements. OHI estimated a compliance rate of 66.2 percent.
The study reported that more than 8 percent of Americans carry the diagnosis of diabetes mellitus1 and the rate exceeds 20 percent among patients treated at VHA hospitals and clinics. Prevention of Amputation in Veterans Everywhere (PAVE) is tasked with preventing and treating lower-limb complications that can lead to amputation in these VA patients. The program provides for the identification of at-risk individuals and describes four levels of foot risk-normal, low, moderate, and high-and specifies actions to be taken for each risk level. Many of these actions are the responsibility of primary care providers, with augmentation by referrals to podiatrists, vascular surgeons, and other healthcare professionals trained to provide specialized foot care.
The study population consisted of patients with a diagnosis of diabetes mellitus and one or more of the following risk factors for amputation during July 1, 2009-February 28, 2010: peripheral vascular disease, peripheral neuropathy, and Charcot joint disease with foot deformity. OHI used a two-stage approach to evaluate the annual rate of patient encounters with the VA or fee-basis foot care specialists. First, administrative data for 82,305 patients was examined for evidence of specialized foot care and then a focused electronic health record review was conducted of a randomly selected sample of 623 patients for whom there was no evidence of annual care in administrative data.
OHI estimated the VHA compliance rate for annual foot care in this population at increased risk to be 66.2 percent.
OHI recommended that the Under Secretary for Health implement a plan to ensure compliance with VHA’s requirement that patients who are at moderate or high risk for amputation be examined by a foot care specialist at least once each year. The Under Secretary for Health concurred with the findings and recommendations.
