Impact of case‐mix adjustment on observed variation in the healing of diabetic foot ulcers at 12 weeks using data from the National Diabetes Foot Care Audit of England and Wales: A cohort study
Authors' conclusion
Variation in the healing of diabetic foot ulcers between specialist services in England and Wales persisted after adjusting for demographic characteristics, ulcer severity, smoking, body mass index and co-morbidities. We conclude that other factors contribute to variation in healing of diabetic foot ulcers and include the time to specialist assessment.
Study context
- Population
- People with DFU presenting to specialist services in England and Wales, July 2014–March 2018 (National Diabetes Foot Care Audit); 120 servicesvalid outcome data
- Participants
- 27,030 people
- Outcome
- Alive and ulcer-free
- Follow-up
- 12 weeks from presentation
Methodological detailsnational audit, logistic regression with case-mix adjustment
- National audit
- Logistic regression with case-mix adjustment
Main finding
As reported in the abstract
12 weeks
- Alive and ulcer-free
- 12,925 (47.8%)
- Unhealed ulcer
- 13,745 (50.9%)
- Died
- 360 (1.3%)
- Services >3SD above national mean after adjustment
- 4 (3.3%)
- Services >3SD below national mean after adjustment
- 7 (5.8%)
Observational data: associations, not effects.
Further findings
Factors associated with worse outcome
- Male sex, more severe ulcers, history of cardiac or renal disease and longer time from first non-specialist presentation to first expert assessment were associated with worse outcome
Original publication
Impact of case‐mix adjustment on observed variation in the healing of diabetic foot ulcers at 12 weeks using data from the National Diabetes Foot Care Audit of England and Wales: A cohort study. Diabet Med. Published 5 October 2022. doi:10.
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