Student Name
Capella University
NURS-FPX 6218 Leading the Future of Health Care
Prof. Name
Date
Change Proposal Summary Report
Diabetes foot care is a crucial element of comprehensive diabetes management, directly impacting patient outcomes and quality of life. However, in many U.S. healthcare settings, the prevention and management of diabetes-related foot complications—such as Diabetic Peripheral Neuropathy (DPN) and foot ulceration—are often overlooked. DPN, a common vascular complication of diabetes, contributes significantly to foot ulcers and amputations, affecting approximately 50% of diabetic patients. This situation not only adversely affects patients’ health outcomes but also substantially increases healthcare costs (Galiero et al., 2023).
This report advocates for enhanced diabetes foot care interventions at the Southern West Virginia Health System (SWVHS), which serves rural communities, including Beckley, West Virginia. The assessment involved a comprehensive review of local practices, comparison with international healthcare systems, and evidence-based recommendations to reduce DPN incidence and prevent foot ulceration among diabetic patients.
Executive Summary
Proposed Change
Diabetes-related foot complications, such as numbness, pain, ulceration, and amputations, are increasingly prevalent among patients in West Virginia. SWVHS faces significant challenges in managing diabetic foot care due to healthcare inequities, limited access to specialists, and socioeconomic barriers (Minc et al., 2020). Addressing these issues requires focused interventions to improve patient monitoring and early intervention for foot complications.
The proposed changes include:
- Expanding routine diabetes check-ups, including HbA1c testing and foot examinations.
- Implementing telehealth services to increase patient contact with healthcare providers for guidance and monitoring.
These initiatives are particularly critical in SWVHS, where diabetes prevalence is high—223,338 individuals (15.7% of the population) live with diabetes in West Virginia (ADA, n.d.). Improved monitoring and access to care are expected to reduce the development of DPN and foot ulceration.
Evidence Supporting the Change
Approximately 10,473 people in West Virginia develop diabetes annually, indicating a high risk for diabetic foot complications (ADA, n.d.). Evidence-based strategies recommended by the American Diabetes Association (ADA), such as routine foot inspections, HbA1c monitoring, and telemedicine interventions, have been shown to reduce the onset and progression of DPN (Hazenberg et al., 2020).
Regular foot examinations integrated with Electronic Health Record (EHR) alerts can streamline patient care and enable timely intervention (Zhao et al., 2023). These improvements are expected to enhance patient outcomes, reduce healthcare costs, and improve the overall quality of life for diabetic populations served by SWVHS.
Desired Outcomes
The primary goal of the proposed interventions is the prevention of diabetes-related foot complications, including ulcers and amputations. Key expected outcomes include:
- Reduction in foot complications: Early detection and treatment of ulcers and neuropathy.
- Enhanced access to care: Use of telehealth to provide services to underserved rural areas.
- Improved glycemic control and safety: EHR-integrated reminders for regular foot checks and HbA1c monitoring.
The financial and logistical requirements for these interventions include funding from Medicaid, federal programs, private insurers, and hospital resources. Potential barriers include initial costs of EHR integration and staff resistance due to increased workload (Casadei et al., 2021). Successful implementation relies on sufficient resources and interprofessional collaboration.
Health Care System Comparative Analysis
Comparing SWVHS to international systems highlights best practices that can be adapted locally:
| Health System | Guidelines/Protocols | Key Practices | Outcomes |
|---|---|---|---|
| United Kingdom (NHS) | NICE guidelines | Multidisciplinary foot care teams, risk assessment, e-learning for patient self-management | Reduced foot complications, improved care coordination (NHS, n.d.) |
| Australia | NHMRC guidelines | Telehealth for foot monitoring, patient education, annual low-risk foot checks | Effective DPN management, improved access in remote areas (Kaminski et al., 2022) |
| SWVHS (USA) | Current local protocols | Limited resources, low access in rural areas, insufficient patient education | High rates of DPN, foot ulcers, and amputations; potential improvement with proposed change (Minc et al., 2020) |
International practices emphasize multidisciplinary teams, patient education, and telehealth interventions. Adopting these approaches in SWVHS can bridge healthcare gaps in rural areas, improve monitoring, and reduce complications.
Rationale for the Proposed Change
Implementing staff training, multidisciplinary care models, and telehealth integration, as practiced in the NHS and Australian systems, is projected to improve diabetes foot care outcomes at SWVHS. Following NICE and NHMRC guidelines will allow for:
- Early identification of DPN and ulcers
- Enhanced patient self-management
- Continuity of care through telehealth
Multidisciplinary team-based care ensures that diabetic patients receive comprehensive support for foot health, including education on self-care practices (Choi et al., 2023). Telehealth allows real-time monitoring and guidance, which is feasible given SWVHS’s existing infrastructure. Overall, aligning SWVHS practices with global standards will improve patient safety and health outcomes.
Financial and Health Implications
Implementing telehealth services, multidisciplinary approaches, and EHR-supported foot screenings has significant economic and health benefits:
- Short-term: Increased accessibility, improved patient satisfaction, and early detection of complications.
- Long-term: Reduced treatment costs for severe neuropathy, lower hospitalization rates, and improved quality of life (Felix et al., 2023; Hazenberg et al., 2020).
Although upfront costs for telehealth and EHR integration are required, the long-term savings and improved outcomes outweigh initial expenses. Failure to implement these changes may result in severe DPN, limb amputations, and increased healthcare costs, as ulcer treatment expenses are up to five times higher than for patients without ulcers (Felix et al., 2023).
Conclusion
Adopting telehealth solutions, regular foot screenings, and multidisciplinary care models at SWVHS will strengthen diabetes foot care management, reduce the incidence of DPN and foot ulcers, and improve health equity in rural West Virginia. Learning from NHS and Australian approaches ensures comprehensive care delivery, better patient outcomes, and long-term cost efficiency.
References
ADA. (n.d.). The burden of diabetes in West Virginia. American Diabetes Association. https://diabetes.org/sites/default/files/2023-09/ADV_2023_State_Fact_sheets_all_rev_West%20Virginia.pdf
Casadei, G., Filippini, M., & Brognara, L. (2021). Glycated hemoglobin (HbA1c) as a biomarker for diabetic foot peripheral neuropathy. Diseases, 9(1), 16. https://doi.org/10.3390/diseases9010016
Choi, T., Osuagwu, U. L., Tran, C., Bulsari, K., & Simmons, D. (2023). Impact of multidisciplinary care of diabetic foot infections for inpatients at Campbelltown Hospital. BMC Health Services Research, 23(1), 1126. https://doi.org/10.1186/s12913-023-10119-0
NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change
Felix, Uçkay, I., Boixader, S. L., Sydler, C., & Gariani, K. (2024). Current knowledge of morbidities and direct costs related to diabetic foot disorders: A literature review. Frontiers in Endocrinology, 14, 1323315. https://doi.org/10.3389/fendo.2023.1323315
Galiero, R., Caturano, A., Vetrano, E., Beccia, D., Brin, C., Alfano, M., & Sasso, F. C. (2023). Peripheral neuropathy in diabetes mellitus: Pathogenetic mechanisms and diagnostic options. International Journal of Molecular Sciences, 24(4), 3554. https://doi.org/10.3390/ijms24043554
Hazenberg, C. E., aan de Stegge, W. B., Van Baal, S. G., Moll, F. L., & Bus, S. A. (2020). Telehealth and telemedicine applications for the diabetic foot: A systematic review. Diabetes/Metabolism Research and Reviews, 36(3), e3247. https://doi.org/10.1002/dmrr.3247
NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change
Kaminski, M. R., Golledge, J., Lasschuit, J. W. J., Schott, K., Charles, J., Cheney, J., & Raspovic, A. (2022). Australian guideline on prevention of foot ulceration: Part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. Journal of Foot and Ankle Research, 15(1). https://doi.org/10.1186/s13047-022-00534-7
Minc, S. D., Hendricks, B., Misra, R., Ren, Y., Thibault, D., Marone, L., & Smith, G. S. (2020). Geographic variation in amputation rates among patients with diabetes and/or peripheral arterial disease in the rural state of West Virginia identifies areas for improved care. Journal of Vascular Surgery, 71(5), 1708–1717. https://doi.org/10.1016/j.jvs.2019.06.215
NHS. (n.d.). Northwest Coast strategic clinical network diabetes footcare pathway blueprint. National Health Service. https://www.england.nhs.uk/north/wp-content/uploads/sites/5/2018/05/NWCSN_Diabetes_Footcare_Final_Report_2017-1.pdf
NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change
Zhao, N., Xu, J., Zhou, Q., Hu, J., Luo, W., Li, X., Ye, Y., Han, H., Dai, W., & Chen, Q. (2023). Screening behaviors for diabetic foot risk and their influencing factors among general practitioners: A cross-sectional study in Changsha, China. BMC Primary Care, 24(1). https://doi.org/10.1186/s12875-023-02027-3