Background
To support Ontario Health’s Lower-Limb Preservation Strategy (LLPS), the DET OHT designed and implemented lower-limb care pathways for the DET community. These pathways focus on providing primary and community care for foot and wound care to individuals with diabetes or peripheral artery disease.
The project aims to:
- Reduce preventable, non-traumatic major lower limb amputations across Downtown East Toronto.
- Enhance equitable care pathways for early identification, cardiovascular risk management, diabetes management, and wound care.
Why This Project?
Compared to similar publicly funded jurisdictions, Ontario has one of the highest rates of lower-limb amputation related to diabetes and peripheral artery disease.
According to the provincial data:
- 30% live with diabetes or prediabetes, and 10% live with diagnosed diabetes. (1)
- People with diabetes are almost 20 times more likely to be hospitalized for a non-traumatic lower-limb amputation compared to the general population. (1)
- 15-20% of people over 70 years are estimated to have peripheral vascular disease. (2)
- There are 1,200 non-traumatic major lower-limb amputations annually, which equates to one amputation every 7 hours. (3)
- 85% of the lower-limb amputations related to diabetes or peripheral artery disease are preventable. (3)
- Direct amputation healthcare cost accounts for approximately $140 million annually. (3)
Milestones and Achievements
The project team uncovered significant disparities in the preventive and timely delivery of foot care and wound management. They recognized challenges encountered by both clients and providers in accessing support services and navigating the complex health care system.
The analysis highlighted the need for a streamlined screening and care escalation process and an increase in community-based chiropody capacity to improve access to specialized foot care services.
As a result, the project team implemented client- and provider-focused pathways for:
- Screening and Prevention
- Escalation of Care
Screening and Prevention
Under this pathway, the multidisciplinary experts collaborated to:
- educate patients and providers on timely examination of feet, especially for people at high risk of complications
- standardize and create screening capacity
- leverage information-sharing systems across organizations within DET OHT to flag and facilitate foot care for high-risk patients
One of the outcomes from these efforts was the creation of foot screening tool that was shared with primary and community care providers partnering on the project.
To reduce complications of the lower limb and manage wounds effectively, this pathway:
- defined a referral/management pathway for foot wounds
- dedicated a community-based clinical care consultant/navigator to support screening and prevention change initiatives
- dedicated a hospital-based clinical care consultant/navigator to support coordinating multidisciplinary lower-limb care (chiropody, vascular, orthopedics, diabetes) in St. Michael’s Hospital ambulatory settings
One of the outcomes of this pathway was the creation of care escalation and referral tool that was shared with primary and community care providers partnering on the project.
VIEW ESCALATION OF CARE AND REFERRAL TOOL
Caring for Your Feet
- Preventing Wounds and Amputations in People With Diabetes
- Regular Care Habits for Healthy Feet – Part 1 of 2
- Regular Care Habits for Healthy Feet – Part 2 of 2
- Preventive Primary Care for Diabetes and Foot Health
- Melanie Ashkewe’s Story: From Addiction to Managing Diabetes and Foot Care
More Stories
- Lower Limb Preservation Uses New Technology for Diabetic Foot Wound Care
- “The real secret sauce – the magic ingredient – was the structure underneath the pathway”: design thinking expert reflects on the lower limb care strategy
- “The hope is that everyone is getting care from the right place at the right time”: Two health care providers discuss timely intervention and prevention for lower-limb care
- Putting Feet First: DET OHT Unveils New Strategies to Reduce Lower-Limb Amputations
- Lower-Limb Care Program of the DET OHT is Gearing Up to Launch