SS09 - VISTA: Targeting Diabetes-Related Lower Extremity Amputations among Underrepresented Communities through a Patient-Centered Multidisciplinary Approach

Objectives: Diabetes-related lower extremity amputations (LEA, defined as minor amputations, transmetatarsal amputation; TMA and below the knee amputation; BKA) disproportionately impact racial minorities and low-income groups. We aim to assess the association of the Vascular Volunteers in Service to All (VISTA) needs assessment tool upon non-traumatic amputations in a regional, urban underserved community.

Methods: Prospective single-center cohort of consecutive patients presenting with diabetic foot ulceration/infection (DFU/DFI). We collected demographics, wound ischemia foot infection (WIfI) stage, co-morbidities, peri- and post-procedural data and results of the VISTA needs assessment tool that measures socio-economic factors, barriers and a qualitative analysis of patient perception of care.

Results: Over one year, we enrolled 101 consecutive patients and limbs (median 60 (IQR 52, 65); male N=59 (74%), comprised of Hispanics (63.4%), Blacks (27.7%), and Whites (7.9%). There were 63 LEA (34 minor amputations/ 8 TMA /21 BKA; 62.4%, among which 45 (44.5%) LEA occurred at baseline admission and 18 (17.8%) occurred after discharge. Hospital median length of stay ranged from 4 to 14.5 days. Treatment included toe/forefoot amputations (42 patients), debridement (56 patients), and major amputations (21 patients). A significant finding was an increase in major amputations, particularly below-knee, during the three-month follow-up period. High WIfI ischemia and wound scores (I3 p=0.052 and W3 p=0.003) were predictive of increased risk of limb loss during the study. 84% reported dissatisfaction with their diabetic foot care and over half 51.5% were uninsured. Only 50.5% of the patients had been treated at the wound care specialty clinic and the majority received their diabetes information primarily from TV/radio, secondarily family, and third internet/social media. The VISTA assessment tool identified major barriers to effective care from a patient’s perspective, including financial constraints, systemic issues, time and access limitations, knowledge gaps, and cultural and provider-related factors (Figure1).

Conclusions: VISTA findings underline the necessity to create a multidisciplinary team approach, 'Toe and Flow' model to decrease Lower Limb Amputations due to DFU or DFI in marginalized, low-income minority groups. These insights will allow us to design a community-based awareness campaign to improve outpatient care accessibility, and implement an internal systemic algorithm to promote limb salvage. Emphasis on patient education and healthcare providers' understanding of patients' unique situations will be crucial for success and community outreach.