- Describe your topic.
- Comprehensive Diabetic Lower Extremity Exam (CDLEE). For diabetic patients, what are the risks and benefits of incorporating a CDLEE by a podiatrist (doctor of podiatric medicine) on at least an annual basis in order to risk stratify patients to guide treatment and follow-up planning? The CDLEE consists of visual inspection of the feet and legs for evidence of skin lesions or changes, evaluation of blood flow via pedal pulses, examination of the overall structure of the feet and their relation to the legs as well as determination of the status of peripheral nerve function in the diabetic patient. The CDLEE is performed in order to risk stratify patients with the resultant risk category (based on the results of the exam) guiding follow-up planning in order to monitor those at risk and reduce or prevent complications, such as ulceration, infection, hospitalization and amputation. Could CDLEE risk stratification and subsequent follow-up planning reduce the incidence of complications as described above? Could CDLEE risk stratification prevent complications in the diabetic population? Could the CDLEE improve quality of life in diabetic patients?
- Describe why this topic is important.
- Close to 10 percent of the United States population has diabetes. Twenty-five percent of diabetic patients will experience a foot ulceration in their lifetime. There is an increased risk of infection with an open ulceration, especially in diabetic patients as they experience reduced innate immune system function. Diabetic foot infections are associated with poor clinical outcomes (hospitalization and amputation), significant cost to the patient (morbidity, ambulatory and psycho-social/mental health), society (absenteeism) and to the healthcare system (financial cost). An open ulceration precedes non-traumatic amputation in more than 80 percent of cases. For diabetic patients with peripheral arterial disease, the risk of amputation is even greater. If the CDLEE identifies patients at differing levels of risk, complications (ulceration, infection, hospitalization, and amputation) could be avoided, allowing patients a better quality of life and reduced financial burden on the healthcare system.
- Tell us why you are suggesting this topic.
- An evidence-based report and subsequent resources related to the CDLEE would be beneficial for providers, patients and policy makers. With the information, there could be more of a push for coverage of such screening/prevention services being provided, especially as we move toward value-based care. If the benefits of the CDLEE outweigh any risks and the exam proves successful in reducing and preventing diabetic foot complications, it could result in better outcomes, a healthier population and lower costs associated with diabetic foot complications.
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- The American Diabetes Association guidelines recommend performing a comprehensive foot evaluation at least annually to identify risk factors for ulcers and amputations. Diabetic patients are being evaluated and risk stratified in clinical practice, however, the interval of CDLEE and outcomes directly related to such an exam are unclear. A new evidence report would allow for more information on the benefits of a CDLEE, including the cost-savings of such an exam, and thus better implementation of and possibly payment for the exam at intervals recommended by the risk stratification.
- How will you or your group use the information from a new evidence report?
- The American Podiatric Medical Association will use the information from a new evidence report relating to the CDLEE and diabetic foot complications to educate not only doctors of podiatric medicine on the importance of such an exam, but also other healthcare providers on the importance of early identification/screening to reduce the burden of diabetic foot complications.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- The information from such a report would be disseminated to our membership (the vast majority of the 15,000 practicing podiatric physicians and surgeons in the country), to other healthcare providers/organizations, and to the public, especially those with diabetes and those who care for people with diabetes. Information goes out via a number of channels including print, online and social media outlets.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- Alliance for Patient Access - The AfPA has the Diabetes Therapy Access Working Group focused around public policy surrounding access to treatments for diabetes. The information from a report on CDLEE could be beneficial for the AfPA to share with its stakeholders. The American Podiatric Medical Association would implement the findings as stated above.
- Information About You: (optional)
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- Provide a description of your role or perspective.
- The American Podiatric Medical Association is the national organization representing podiatric physicians and surgeons.
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- American Podiatric Medical Association (APMA)
- Please tell us how you heard about the Effective Health Care Program.
- Regulatory Consultant
