Crossing the Divide: Piloting Integrated Care to Reduce Amputations Among Rural Patients With Diabetic Foot Ulcers

University of Wisconsin (UW)

Status: Completed

Conditions: Diabetic Foot; Amputation; Diabetic Ulcer of Right Foot; Diabetic Ulcer of Left Foot

Treatments: Other: integrated care model

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT05203471

SMPH/MEDICINE/INFECT DIS (Other Identifier)

Protocol Version 2/6/2025 (Other Identifier)

2022-1338

R01DK132569-01 (Other Grant/Funding Number)

Details and patient eligibility

About

This project directly addresses the escalating national rate of major (above-ankle) amputations due to diabetic foot ulcers; it focuses on rural patients, who face 37% higher odds of major amputation compared to their urban counterparts. The project pilots the first integrated care model adapted to rural settings, an approach that has reduced major amputations in urban settings by approximately 40%. Pilot data will be used to improve recruitment and retention strategies and provide preliminary evidence of efficacy needed to conduct a robust, statewide efficacy trial.

Enrollment: 114 patients

Sex: All

Ages: 18 to 89 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Healthcare worker inclusion criteria:

  • Willing to provide informed consent
  • Willing to comply with study procedures
  • Rural providers (primary care physicians at the UW Health Belleville Family Medicine Clinic, diabetes and wound care specialists at Sauk Prairie Healthcare Diabetes and Wound Care Clinic) and schedulers placing referrals.
  • Employed at a participating clinic
  • For rural providers, confirm understanding that they will retain clinical discretion to deviate from the integrated care model if they think it would best serve the patient.
  • Available for the duration of the study

• Patient inclusion criteria:

  • Able and willing to provide informed consent.
  • Willing to comply with study procedures and be available for the duration of the study.
  • 18 years of age and older.
  • Patient with either type 1 or type 2 diabetes at a participating rural clinic.
  • Develops diabetic foot ulcer during enrollment period.

Exclusion criteria

• Healthcare worker exclusion criteria:

  • Insufficient overlap in work schedules between rural providers and scheduler based on clinic manager determination.

• Patient exclusion criteria:

  • receiving palliative care such that referral to urban centers for aggressive limb salvage would be inappropriate, as assessed by patient rural provider
  • insurance does not cover referral to the University of Wisconsin's specialty clinics
  • Not suitable for study participation due to other reasons at the discretion of the investigators.

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Sequential Assignment

Masking: None (Open label)

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114 participants in 2 patient groups

Historical controls

No Intervention group

Description:

Patients with diabetic foot ulcers cared for by a primary care provider participating in the study prior to launching the integrated care intervention.

Integrated care

Active Comparator group

Description:

Patients with diabetic foot ulcers cared for by a primary care provider participating in the study after launching the integrated care intervention. Only patients who provide informed consent and enroll in the study will be treated with our integrated care model. All other patients with a participating primary care provider will be treated using a standard care model and will not be considered study participants.

Treatment:

Other: integrated care model