Rachel H Albright1, Nivethitha B Manohar2, Jennifer F Murillo2, Linda Anael M Kengne2, Juan J Delgado-Hurtado3, Matthew L Diamond4, Alyse L Acciani4, Adam E Fleischer5. 1. The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Hanover, NH, United States. Electronic address: albrightrh@gmail.com. 2. The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Hanover, NH, United States. 3. The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Hanover, NH, United States; Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States. 4. Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States. 5. Department of Podiatric Medicine and Radiology, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States.
Abstract
AIMS: To determine the pooled effectiveness of multidiscipinary care teams (MCTs) in reducing major amputation rates in adults with diabetes. METHODS: A systematic review and meta-analysis was performed, searching databases MEDLINE, EMBASE, Google Scholar, Cochrane Library, and Clinicaltrials.gov thru October 2018. We included only before-after studies comparing amputation rates before and after the implementation of a MCT for the prevention of major amputation in adults with diabetes. Our primary outcome was relative risk of major amputation. Risk ratios and 95% confidence intervals were calculated using a fixed effects model. RESULTS: Twenty studies met the inclusion criteria. Nine studies were included in the meta-analysis, and eleven were included in a qualitative analysis. Exposure to a MCT resulted in a protective effect ranging from a RR of 0.44 [p-value < 0.00001 (95% CI 0.38, 0.51) I2 = 67%] to a RR of 0.61 [p-value < 0.0001, (95% CI 0.50, 0.75) I2 = 0%] after sensitivity analysis, and remained robust in qualitative analysis. CONCLUSIONS: Healthcare systems can expect a 39-56% amputation rate reduction after implementing an MCT amputation prevention program. These findings may justify the use of additional resources needed for program implementation by helping healthcare systems predict the anticipated benefit these teams have on "possible limbs saved". FUNDING: None.
AIMS: To determine the pooled effectiveness of multidiscipinary care teams (MCTs) in reducing major amputation rates in adults with diabetes. METHODS: A systematic review and meta-analysis was performed, searching databases MEDLINE, EMBASE, Google Scholar, Cochrane Library, and Clinicaltrials.gov thru October 2018. We included only before-after studies comparing amputation rates before and after the implementation of a MCT for the prevention of major amputation in adults with diabetes. Our primary outcome was relative risk of major amputation. Risk ratios and 95% confidence intervals were calculated using a fixed effects model. RESULTS: Twenty studies met the inclusion criteria. Nine studies were included in the meta-analysis, and eleven were included in a qualitative analysis. Exposure to a MCT resulted in a protective effect ranging from a RR of 0.44 [p-value < 0.00001 (95% CI 0.38, 0.51) I2 = 67%] to a RR of 0.61 [p-value < 0.0001, (95% CI 0.50, 0.75) I2 = 0%] after sensitivity analysis, and remained robust in qualitative analysis. CONCLUSIONS: Healthcare systems can expect a 39-56% amputation rate reduction after implementing an MCT amputation prevention program. These findings may justify the use of additional resources needed for program implementation by helping healthcare systems predict the anticipated benefit these teams have on "possible limbs saved". FUNDING: None.
Authors: Byron M Perrin; Anita Raspovic; Cylie M Williams; Stephen M Twigg; Jonathan Golledge; Emma J Hamilton; Anna Crawford; Carol Hargreaves; Jaap J van Netten; Nytasha Purcell; Peter A Lazzarini Journal: BMJ Open Diabetes Res Care Date: 2021-11
Authors: Lauren Ward; Anne McMurray; Chi Kin Law; Gabor Mihala; Martin Connor; Paul Scuffham Journal: Int J Integr Care Date: 2021-09-15 Impact factor: 5.120