Pay For Performance: How Will It Impact Diabetic Foot Care?

Volume 20 - Issue 6 - June 2007
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Basic Interventions For Diabetic Foot Ulcer Care

• Prescribe offloading
• Screen for osteomyelitis in high risk wounds
• Monitor hemoglobin HbA1c (Level of evidence = C)
• Consider the use of growth factors for Wagner grade I or II ulcers. (Level of evidence = A)
• Consider hyperbaric oxygen therapy (HBOT) for Wagner grades III and IV(WOCN). (Level of Evidence =A)

The list above represents an abbreviation of the Wound Ostomy Continence Nurses (WOCN) guidelines for diabetic foot ulcer care. They are stratified according to the American Heart Association’s “Levels of Evidence” system.

Pay For Performance: How Will It Impact Diabetic Foot Care?

Author(s):

By Caroline E. Fife, MD

References
1.    Siwicki B. Outpatient electronic records. Tackling the challenges. Health Data Management, May 1997, 5: 66-68, 70, 74, 76-78, 81.
2.     Khoury A. Support of Quality and Business Goals by an Ambulatory Automated Medical Record System in Kaiser Permanente of Ohio. Effective Clinical Practice, October/November 1998, 1: 73-82.
3.     CPRI Workgroup. Valuing CPR Systems: A Business Planning Methodology. Schaumburg, IL: Computer-based Patient Record Institute, 1997.
4.     HIMSS Electronic Health Record Definitional Model Version 1.0 2004.
5.     Adult diabetes: percentage of smokers who were recommended or offered an intervention for smoking cessation (i.e., counseling or pharmacologic therapy). National Diabetes Quality Improvement Alliance 2003 May. NQMC:000616. Accessed at www.qualitymeasures.ahrq.gov.
6.    Adult diabetes: percentage of patients receiving at least one complete foot examination (visual inspection, sensory exam with monofilament, and pulse exam). National Diabetes Quality Improvement Alliance 2003 May. NQMC:000610. Accessed at www.qualitymeasures.ahrq.gov.
7.     Adult diabetes: percentage of patients receiving one or more A1c test(s). National Diabetes Quality Improvement Alliance 2003 May. NQMC:000596. Accessed at www.qualitymeasures.ahrq.gov.

Additional References
8.     Shortliffe EH. The evolution of electronic medical records, Academic Medicine 1999;74(4):414-419.
9.     Dassenko D, Slowinski T. Using the CPR to benefit a business office. Healthcare Financial Management, July 1995, 49: 68-70, 72-73.
10.    Mildon J, Cohen T. Drivers in the electronics medical records market. Health Manage Tech, May 2001;22: 14-6, 18.
11.    Fife CE, Walker D, Farrow W, Otto GH. Wound center facility billing: a retrospective analysis of time, wound size, and acuity scoring for determining facility level of service. Ostomy Wound Manage 53(1); 34-44, 2007.