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Clinical Research
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The high-low amputation ratio: toward a common measure of quality of diabetic foot care? First Author: David Armstrong Authors: David G Armstrong, James S Wrobel, Jeff M Robbins Objective: Propose a new quality measure that gives further insight into high risk foot surveillance and limb salvage beyond foot screening exams. Examine the utility of the Hi-Lo amputation measure through its discrimination of amputation profile. Research Design and Methods: Retrospective cohort study using administrative data in hospital referral regions. Patients will consist of Medicare population. Main outcome measures will be Hi-Lo amputation ratio, major and minor amputation rates adjusted for age gender and race. Results: The mean Hi-Lo ratio was 1.35 with a standard deviation of 0.42. The lowest ratio was 0.56 and highest ratio was 3.43 yielding a 6.1-fold degree of variation. The correlation coefficient for the Hi-Lo ratio with major amputation rate was 0.48 (p=0.0000; R2 =0.23). For the top 10th percentile centers, the correlation coefficient for the Hi-Lo ratio with major amputation rate was -0.27 (p=0.0000) and minor amputation rate 0.36 (p=0.0000). For the lowest 90th percentile centers, the correlation coefficient for the Hi-Lo ratio with major amputation rate was 0.33 (p=0.0000) and minor amputation rate -0.30 (p=0.0000). Conclusions: The Hi-Lo measure demonstrates face validity, yet only a small proportion of the variance is described by local propensity to perform major amputation or by major amputation rates alone. The authors believe the Hi-Lo measure to be an important for giving insight into local high-risk foot surveillance and limb salvage efforts. In this country to date, we have relied on the foot screening measure alone, perhaps explaining why major amputation rates have not dropped. |
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