%0 Journal Article %J European Journal of Public Health %D 2024 %T A multidisciplinary Delphi consensus to define evidence-based quality indicators for diabetic foot ulcer care. %A Flora Mbela Lusendi %A An-Sofie Vanherwegen %A Frank Nobels %A Giovanni Matricali %K Delphi Technique %K diabetic foot ulcer %K quality indicators %K quality of care %X

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.

%B European Journal of Public Health %G eng %0 Generic %D 2023 %T CREATION OF A ‘PRECISION PROGNOSTIC CLASSIFICATION’ FOR DIABETIC FOOT ULCER HEALING WITH THE USE OF A BOTTOM-UP APPROACH %A Flora Mbela Lusendi %A Giovanni Matricali %A An-Sofie Vanherwegen %A Kris Doggen %A Frank Nobels %B 9th International Symposium on the Diabetic Foot %G eng %0 Generic %D 2023 %T Evidence-based quality indicators in diabetic foot care: the Belgian multidisciplinary expert panel opinion %A Flora Mbela Lusendi %A An-Sofie Vanherwegen %A Frank Nobels %A Giovanni Matricali %B 9th International Symposium on the Diabetic Foot %C The Hague, The Netherlands %G eng %0 Journal Article %J Diabetes Research and Clinical Practice %D 2022 %T Bottom-up approach to build a ‘precision’ risk factor classification for diabetic foot ulcer healing. Proof-of-concept %A Flora Mbela Lusendi %A Giovanni Arnoldo Matricali %A An-Sofie Vanherwegen %A Kris Doggen %A Frank Nobels %K classification %K Diabetic Foot %K Prediction model %K quality improvement %K wound healing %X

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.

%B Diabetes Research and Clinical Practice %V 191 %8 2022-08-01 %G eng %& 110028 %R 10.1016/j.diabres.2022.110028