RESUMEN
PURPOSE: To determine if age, gender, risk level and glucosylated hemoglobin could predict foot amputations in HMO patients with diabetes. DATA SOURCES: A retrospective chart review of a non-random sample of 27 patients with amputation and 110 randomly selected patients without amputation during the same time period. Chi-square, t-tests and logistic regression were used to analyze the data. CONCLUSIONS: There was no significant difference between the group with amputation and those without amputation in age or gender. However, there was a significant difference between the two groups in the risk stratification (p = .005) and glycosylated hemoglobin levels (p = .058). IMPLICATIONS FOR PRACTICE: Nurse practitioners can effectively screen for amputation risk factors and closely monitor glycosylated hemoglobin levels of diabetic patients to reduce the incidence of vascular complications and related lower extremity amputation.
Asunto(s)
Amputación Quirúrgica , Pie Diabético/cirugía , Hemoglobina Glucada/análisis , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Complicaciones de la Diabetes , Pie Diabético/etiología , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Enfermeras Practicantes , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Factores SexualesRESUMEN
We used the fully automated medical record system at Kaiser Permanente of Ohio to direct appropriate interventions to diabetic patients at risk for amputation. The computer identified all patients with a diagnosis of diabetes, reminded physicians, at the moment of care, of the need to enter the patient's risk status for amputation, and kept track of patients at medium or high risk for amputation who were due for an evaluation with education in the podiatry department. Two years and four months after activation of this reminder system, the risk level had been determined for 76% of the diabetic population (n = 10,000), and two thirds of those at medium or high risk had received the appropriate intervention. In patients in the medium and high risk groups, the risk ratio for amputation was 17.5.