TY - JOUR
T1 - The High-Low Amputation Ratio
T2 - A Deeper Insight into Diabetic Foot Care?
AU - Wrobel, James S.
AU - Robbins, Jeff
AU - Armstrong, David G.
PY - 2006/11/1
Y1 - 2006/11/1
N2 - The purpose of this study was to propose and evaluate a high to low (Hi-Lo) amputation ratio as a potential additional quality measure giving further insight into high-risk foot surveillance beyond foot screening examinations. As part of the Dartmouth Atlas of Health Care project, a secondary analysis was performed on Medicare administrative data. Amputation rates were adjusted for age, gender, and race. This included 37,808 minor (foot-level) amputations and 44,599 major amputations from 1996 to 1997. We also calculated the longitudinal national trends in the Hi-Lo ratio with data from the Centers for Disease Control and Prevention from 1992 to 2002. The adjusted mean Hi-Lo ratio was 1.35 (standard deviation, 0.42). The lowest ratio was 0.56, and the highest ratio was 3.43. The correlation coefficient for the Hi-Lo ratio with major amputation rate was 0.48 (P < .0001; R2 = 0.23). Similar correlations were found for the highest and lowest percentiles for major and minor rates. The Centers for Disease Control and Prevention data of the Hi-Lo ratio using the crude and age-adjusted rates suggest stable trends in the ratio over a decade. 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 United States has relied on a foot screening measure alone, perhaps explaining why major amputation rates have not substantively declined. If we are to reduce the amputation burden, we should begin with a straightforward measure that can be implemented at most any center.
AB - The purpose of this study was to propose and evaluate a high to low (Hi-Lo) amputation ratio as a potential additional quality measure giving further insight into high-risk foot surveillance beyond foot screening examinations. As part of the Dartmouth Atlas of Health Care project, a secondary analysis was performed on Medicare administrative data. Amputation rates were adjusted for age, gender, and race. This included 37,808 minor (foot-level) amputations and 44,599 major amputations from 1996 to 1997. We also calculated the longitudinal national trends in the Hi-Lo ratio with data from the Centers for Disease Control and Prevention from 1992 to 2002. The adjusted mean Hi-Lo ratio was 1.35 (standard deviation, 0.42). The lowest ratio was 0.56, and the highest ratio was 3.43. The correlation coefficient for the Hi-Lo ratio with major amputation rate was 0.48 (P < .0001; R2 = 0.23). Similar correlations were found for the highest and lowest percentiles for major and minor rates. The Centers for Disease Control and Prevention data of the Hi-Lo ratio using the crude and age-adjusted rates suggest stable trends in the ratio over a decade. 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 United States has relied on a foot screening measure alone, perhaps explaining why major amputation rates have not substantively declined. If we are to reduce the amputation burden, we should begin with a straightforward measure that can be implemented at most any center.
KW - amputation
KW - diabetes
KW - diabetic foot
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=36549005623&partnerID=8YFLogxK
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U2 - 10.1053/j.jfas.2006.09.015
DO - 10.1053/j.jfas.2006.09.015
M3 - Article
C2 - 17145462
AN - SCOPUS:36549005623
VL - 45
SP - 375
EP - 379
JO - Journal of Foot and Ankle Surgery
JF - Journal of Foot and Ankle Surgery
SN - 1067-2516
IS - 6
ER -