A comparison of diabetic foot ulcer patients managed in VHA and non-VHA settings

Objective: To compare patients with diabetes and new onset foot ulcers treated in Veterans Health Administration (VHA) and non-VHA settings. Methods: The treatment of patients with new onset diabetic foot ulcers was prospectively monitored in three VHA and three non-VHA hospitals and outpatient settings until ulcer healing, amputation, or death. Results: Of the 302 individuals enrolled in this study, 47% were veterans receiving VHA care. There were no significant differences between veterans and nonveterans in baseline wound classification, diabetes severity, or comorbid conditions. Veterans received significantly fewer sharp debridements, total contact casts, and custom inserts than their nonveteran counterparts, and they had significantly more x-rays, local saline irrigations, IV antibiotics, and prescriptions for bed rest. The percentage of amputations was higher in veterans but did not achieve statistical significance. Conclusions: Many commonly held stereotypes of veteran men were not found. Veterans and nonveterans with foot ulcers were similar in terms of health and 309 Journal of Rehabilitation Research and Development Vol. 38 No. 3, May/June 2001 Pages 309–317 A comparison of diabetic foot ulcer patients managed in VHA and non-VHA settings Gayle E. Reiber, PhD, MPH; Douglas G. Smith, MD; Janette Carter, MD; Greg Fotieo, MD; H. Gunner Deery II, MD; Jon A. Sangeorzan, MD; Lawrence Lavery, DPM, MPH; Jacqueline Pugh, MD; Bettine Peter-Riesch, MD; Jean-Phillipe Assal, MD; Michael del Aguila, PhD; Paula Diehr, PhD; Donald L. Patrick, PhD; Edward J. Boyko, MD, MP VA Puget Sound Health Care System (152), Seattle, WA 98108 This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Program through project numbers IIR92-097 and RCS 98-353. Address all correspondence and requests for reprints to Gayle E. Reiber, PhD, MPH, VA Puget Sound Health Care System (152), 1660 South Columbian Way, Seattle, WA 98108; email: greiber@u.washington.edu. foot history, diabetes severity, and comorbid conditions. There was considerable variation in treatment of diabetic foot ulcers between VHA and non-VHA care. Yet this variation did not result in statistically significant differences in ulcer outcomes.