TY - JOUR T1 - A multidisciplinary Delphi consensus to define evidence-based quality indicators for diabetic foot ulcer care. JF - European Journal of Public Health Y1 - 2024 A1 - Flora Mbela Lusendi A1 - An-Sofie Vanherwegen A1 - Frank Nobels A1 - Giovanni Matricali KW - Delphi Technique KW - diabetic foot ulcer KW - quality indicators KW - quality of care AB -

Background: Valid measures to assess quality of care delivered to patients with diabetes suffering from diabetic foot ulcer (DFU) are scarce. This study aimed to achieve consensus on relevant and feasible quality indicators (QIs) among stakeholders involved in DFU care, and was conducted as the second part of a Belgian quality indicator selection study that sought to identify QIs for DFU care.

 

Methods: A stakeholder panel, including caregivers from primary care and specialized disciplines active in diabetic foot care as well as a patient organization representative, was recruited. By using the RAND/UCLA Appropriateness Method, stakeholders were asked to rate a list of 42 candidate evidence-based indicators for appropriateness through a 9-point Likert scale. QIs were classified based on the median ratings and the disagreement index, calculated by the inter-percentile range adjusted for symmetry.

 

Results: At the end of a 3-phase process, 17 QIs were judged as appropriate. Among them, five were not previously described, covering the following topics: integration of wound care specialty in the multidisciplinary team, systematic evaluation of the nutritional status of the patient, administration of Low Density Lipoprotein (LDL)-cholesterol lowering medication and protocolized care (implementation of care and prevention management protocols).

 

Conclusions: The identified evidence-based QIs provide an assessment tool to evaluate and monitor quality of care delivered to DFU patients. Future research should focus on their complementarity with the existing QIs and their implementation in clinical practice.

ER - TY - Generic T1 - CREATION OF A ‘PRECISION PROGNOSTIC CLASSIFICATION’ FOR DIABETIC FOOT ULCER HEALING WITH THE USE OF A BOTTOM-UP APPROACH Y1 - 2023 A1 - Flora Mbela Lusendi A1 - Giovanni Matricali A1 - An-Sofie Vanherwegen A1 - Kris Doggen A1 - Frank Nobels JF - 9th International Symposium on the Diabetic Foot ER - TY - Generic T1 - Evidence-based quality indicators in diabetic foot care: the Belgian multidisciplinary expert panel opinion Y1 - 2023 A1 - Flora Mbela Lusendi A1 - An-Sofie Vanherwegen A1 - Frank Nobels A1 - Giovanni Matricali JF - 9th International Symposium on the Diabetic Foot CY - The Hague, The Netherlands ER - TY - JOUR T1 - Bottom-up approach to build a ‘precision’ risk factor classification for diabetic foot ulcer healing. Proof-of-concept JF - Diabetes Research and Clinical Practice Y1 - 2022 A1 - Flora Mbela Lusendi A1 - Giovanni Arnoldo Matricali A1 - An-Sofie Vanherwegen A1 - Kris Doggen A1 - Frank Nobels KW - classification KW - Diabetic Foot KW - Prediction model KW - quality improvement KW - wound healing AB -

Aims: Diabetic foot ulcers (DFU) have a complex multifactorial pathophysiology. It is crucial to identify essential prognostic variables to streamline therapeutic actions and quality-of-care audits. Although SINBAD and University of Texas (UT), the most frequently used prognostic classification systems, were prospectively validated, not all individual parameters were shown to have consistent associations with healing. In this study, we used a bottom-up approach relying on robust methods to identify independent predictors of DFU healing.

Methods: 1,664 DFU patients were included by 34 Belgian diabetic foot clinics (DFCs). Twenty-one patient- and foot-related characteristics were recorded at presentation. Predictors of healing were identified using multivariable Cox proportional hazard regression. Multivariable models were built using backward regression with multiple imputation of missing values and bootstrapping.

Results: Five essential independent variables were identified: presentation delay, history of minor amputation, ulcer location, surface area and ischemia. This 5 variable-model showed a better performance compared to models based on existing classification systems.

Conclusions: A bottom-up approach was used to build a prognostic classification for DFU healing based on large databases. It offers new insights and allows to tailor the classification to certain clinical settings. These 5 parameters could be used as a 'precision classification' for specialized DFCs.

VL - 191 M3 - 10.1016/j.diabres.2022.110028 ER -