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Health Services Research & Development

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2006 HSR&D National Meeting Abstract

3010 — Facility Level Variation in Patient Footcare Education: Implications for Performance Measurement

Author List:
Rajan M (Center for Healthcare Knowledge Management)
Pogach LM (Center for Healthcare Knowledge Management)
Tseng C (Center for Healthcare Knowledge Management)
Reiber G (Health Services Research & Development, VA Puget Sound Health Care System)
Johnston MV (Kessler Medical Rehabilitation Research & Education Corporation)

Reducing amputations in high-risk populations is a major VA healthcare mission, and educating veterans about footcare practices is a major component of the VA PACT program. However, little is known about the effectiveness of the educational component of PACT programs. Our objective was to evaluate facility level variation in patient-reported knowledge of recommended footcare practices.

A footcare survey was mailed to a random sample of 1836 diabetic veterans with high-risk foot conditions at eight Veterans Administration facilities; 44% (n=772) responded. Survey scales assessed both basic footcare education (individual items such as how to inspect feet) and specialized education (individual items such as cutting nails and shaving calluses). Linear regression was used to evaluate facility level variation in footcare education, adjusting for age, schooling, neuropathy, a general health rating, and foot ulcers.

Participants average age was 67 years, 94% were male and 34% had 13 or more years of education. VA facilities varied in their footcare education, as perceived by patients. For example, 32% of patients reported receiving no or minimal education on how to check feet regularly (range 24% to 45%) and 42% for choosing proper shoes (range 44% to 52%). Nearly half of subjects (48.6) were uncertain of when to seek care for a foot problem. To evaluate the significance of facility level variation we utilized a basic education [alpha chronbach of 0.89] and a specialized education subscale [0.92]. The mean basic education score was 3.08 on a 4-point scale (facility range =2.9-3.3), where 3 indicates some education "but would like to know more" and 4 indicates "enough knowledge". The specialized education score was 2.52 (facility range = 2.2 – 2.8). There were significant (P<0.005) differences among facilities in basic and specialized footcare education; these differences persisted after adjustment for background and prior health conditions.

Patient-reported education on footcare recommendations is suboptimal, and varies significantly among facilities.

We propose that patient reported education could be used as a “patient centered care” performance measure to assess effectiveness of diabetes footcare education provided by a healthcare system.

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