Reducing ampulation rates in patients with diabetes at a military medical center - The Limb Preservation Service model

OBJECTIVE- To describe and evaluate the Limb Preservation Service (LPS), a multidisciplinary, state-of-the-art, foot care clinic for patients With diabetes at Madigan Army Medical Center (MAMC). Evaluation criteria include the overall incidence of lower-extremity amputation (LEA) and the distribution of the anatomic level of amputation between 1999 and 2003. RESEARCH DESIGN AND METHODS- This is a retrospective study of the incidence and types of LEAs performed in patients with diabetes at MAMC. Patients with diagnosed diabetes and LEA procedures were identified by ICD-9-Clinical Modification (CM) codes. Hospital and clinic characteristics that are integral to the Success Of the program are described. RESULTS- The number Of patients at MAMC With diagnosed diabetes increased 48% front 1999 to 2003; however, the number of LEAs decreased 82% from 33 in 1999 to 9 in 2003. Amputations of the foot, ankle and toe comprise 71 % of amputations among patients With diabetes. CONCLUSIONS- The results Of this study provide evidence of the value of I focused multidisciplinary foot care program for patients with diabetes. Associations between the creation of the LPS and LEA rates are discussed.