Quality of Diabetic Foot Ulcer Care: Evaluation of an Interdisciplinary Wound Care Clinic Using an Extended Donabedian Model Based on a Retrospective Cohort Study

Patry, Jérôme; Tourigny, André; Mercier, Marie-Philippe; Dionne, Clermont E.

doi:10.1016/j.jcjd.2020.09.020

Cited by 7 publications

(10 citation statements)

References 28 publications

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“…While this model of care was previously evaluated through a Donabedian classical approach and meets specific quality indicators of care of structures, processes, and outcomes, the perception of patients was essential to evaluate for a broader evaluation of care quality. 23 All Indexes of Measures are considered high, with higher PR scores than SI scores, except for 1 dimension. This suggests a high balance of care quality.…”

Section: Discussionmentioning

confidence: 99%

“…Scores of perceived-reality were also high. While this model of care was previously evaluated through a Donabedian classical approach and meets specific quality indicators of care of structures, processes, and outcomes, the perception of patients was essential to evaluate for a broader evaluation of care quality 23…”

Section: Discussionmentioning

confidence: 99%

“…The setting of the clinic and characteristics of the interdisciplinary team were described in an earlier publication. 23 All patients of 18 years of age and older with diabetes and with a recently healed plantar DFU as defined by the International Working Group on Diabetic Foot 27 and treated in our setting were eligible for this study. Healing was defined as complete epithelialization of the ulcer following debridement, based on the clinical judgment of the interprofessional team.…”

Section: Methodsmentioning

confidence: 99%

“…[12][13][14][15][16] The interdisciplinary team approach has been associated with positive clinical outcomes for patients with a DFU in Canada based on observational studies, [17][18][19][20][21][22][23] but also in terms of DFU care based on an evaluation based on Donabedian indicators of structure-processes-outcomes. 7,23 However, the patients' perspective on quality of care of such a model of care remains to be established. Therefore, the aim of this study was to evaluate patients' perception and quality of DFU care delivered by an interdisciplinary team approach.…”

Section: Introductionmentioning

confidence: 99%

“…The interdisciplinary team approach has been associated with positive clinical outcomes for patients with a DFU in Canada based on observational studies,17-23 but also in terms of DFU care based on an evaluation based on Donabedian indicators of structure–processes–outcomes 7,23. However, the patients’ perspective on quality of care of such a model of care remains to be established.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Diabetic Foot Ulcers Based on an Interdisciplinary Team Approach

Patry,

Bourgault,

Blanchette

2024

Journal of Wound, Ostomy &Amp; Continence Nursing

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PURPOSE: The purpose of this study was to evaluate patients’ perception and quality of diabetic foot ulcer (DFU) care delivered by an interdisciplinary team approach (ITA). DESIGN: Exploratory cross-sectional study. SUBJECTS AND SETTING: Twenty patients with a healed plantar DFU were recruited from an interdisciplinary Wound Care clinic of a Canadian University affiliated hospital. Their mean age was 64 years (75% were males [n = 15]), 18 (90%) were living with type 2 diabetes, and 45% (n = 9) had osteomyelitis in the previous year of their enrollment in the study. METHODS: The validated short form of the Quality From the Patient’s Perspective questionnaire was used to evaluate quality of care dimensions (medical-technical competence of the caregivers; physical-technical conditions of the care organization; degree of identity-orientation in the attitudes and actions of the caregivers; and sociocultural atmosphere of the care organization). RESULTS: Respondents reported experiencing a high level of quality care with an ITA. All indicators of patient-perceived reality of care delivered were superior or equal related to their subjective importance in all dimensions of quality care (with scores ranging from 3.85 to 4.00 on a 4-Point Likert scale). Patients’ satisfaction regarding the ITA was high. CONCLUSIONS: Study findings suggest that an ITA model provided high quality of care for treating DFUs for all quality dimensions judged important for patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Treatment of Diabetic Foot Ulcers Based on an Interdisciplinary Team Approach

Patry,

Bourgault,

Blanchette

2024

Journal of Wound, Ostomy &Amp; Continence Nursing

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Development and validation of an incidence risk prediction model for early foot ulcer in diabetes based on a high evidence systematic review and meta-analysis

Chen

Wang

Shang

et al. 2021

Diabetes Research and Clinical Practice

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Organization of Diabetes Care: Time to Move from Theory to Action

Ivers

Halperin

2021

Canadian Journal of Diabetes

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Decades of study has demonstrated the proportion of patients who are not meeting evidence-based targets for management of their diabetes. In this issue of the Journal, Shah et al add to this literature, showing that about one-fifth of the people living with diabetes in Ontario in 2019 had a glycated hemoglobin (A1C) of >8% (1). In their study from Brazil, Bergonsi de Farias and colleagues show that two thirds of their study population were not meeting A1C target levels (2). Patry and colleagues used the framework of structure, process and outcome measures and showed that, despite excellent achievement in structure and process indicators for diabetic foot ulcer management, the outcomes remained suboptimal; the authors hypothesize that additional structural supports are needed to address patient-level factors (3).Why do these gaps in care persist? First, it is crucial to recognize that targets are theoretical and may not be achievable or appropriate at a given time for a given patient. System-level and structural issues conspire to make it difficult for many patients to achieve targets. However, some of the observed gaps between ideal and actual diabetes care are amenable to actions that health-care professionals can take to reduce risk for their patients. Of course, asking health-care professionals to simply "try harder" is no way to sustainably improve quality of care. Telling hard-working health professionals that they are not doing enough, without helping them to systematically practice more effectively, efficiently and equitably, is a recipe for burnout.To help our patients in the best way possible, we need to work smarter, not harder. Changing how we provide care-by implementing best practices in our organization of care-can have as much impact as adding more medicines. Furthermore, improvements in organization of care can efficiently lead to improvements in large groups of those patients who need improvements most, rather than relying on burnout-inducing, one-by-one, try-a-littleharder-next-time strategies (4).Many trials have shown that, in general, common quality improvement strategies, such as audit and feedback, clinician education and reminders, and patient self-management support, are It is time we shift our health services research and policy focus from measuring gaps in care to ensuring best practices for implementation of evidence-based organization of care, at scale, in a sustainable fashion.

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Quality of Diabetic Foot Ulcer Care: Evaluation of an Interdisciplinary Wound Care Clinic Using an Extended Donabedian Model Based on a Retrospective Cohort Study

Cited by 7 publications

References 28 publications

Treatment of Diabetic Foot Ulcers Based on an Interdisciplinary Team Approach

Treatment of Diabetic Foot Ulcers Based on an Interdisciplinary Team Approach

Development and validation of an incidence risk prediction model for early foot ulcer in diabetes based on a high evidence systematic review and meta-analysis

Organization of Diabetes Care: Time to Move from Theory to Action

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