Student Name
Capella University
NURS-FPX 6218 Leading the Future of Health Care
Prof. Name
Date
Change Proposal Summary Report
Effective foot care is an essential element of diabetes management because it plays a major role in improving patient health outcomes and overall quality of life. Despite its importance, preventive diabetic foot care—particularly strategies aimed at preventing complications such as Diabetic Peripheral Neuropathy (DPN) and foot ulceration—is frequently underemphasized in many healthcare organizations across the United States. DPN represents one of the most prevalent complications associated with diabetes and contributes significantly to the development of diabetic foot ulcers and lower-limb amputations. Research indicates that nearly half of individuals living with diabetes may experience complications related to neuropathy and foot ulceration.
These complications not only worsen patient health outcomes but also increase healthcare costs due to long-term treatment, hospitalizations, and rehabilitation services (Galiero et al., 2023). This report summarizes a proposed change designed to improve diabetic foot care practices at Southern West Virginia Health System (SWVHS), which serves rural communities in Beckley, West Virginia. The report includes an evaluation of current practices, identifies gaps in diabetic foot management, and compares healthcare strategies used in international health systems. The objective is to introduce evidence-based improvements that reduce the occurrence of DPN and foot ulcer complications among diabetic patients.
Executive Summary
Proposed Change
Diabetes-related complications, including DPN and limb amputation, have become increasingly concerning within the healthcare system of West Virginia. Patients commonly experience symptoms such as numbness, burning sensations, persistent pain, and the development of foot ulcers that may eventually lead to amputation if left untreated. These issues are particularly evident within the Southern West Virginia Health System (SWVHS), which provides healthcare services to several rural communities.
Given the significant impact of diabetic foot complications on patient wellbeing, implementing targeted changes within SWVHS is essential. Studies show that West Virginia experiences higher diabetes-related amputation rates compared with many other regions in the United States, largely due to healthcare disparities and limited access to preventive care services (Minc et al., 2020). Addressing this issue requires improved screening, better monitoring systems, and expanded patient support mechanisms.
The proposed change focuses on three primary interventions:
- Increasing routine HbA1c testing and foot examinations for early detection of complications.
- Integrating telehealth services to improve communication between healthcare providers and diabetic patients.
- Implementing Electronic Health Record (EHR) alerts to ensure consistent screening and monitoring.
These interventions are particularly necessary because diabetes prevalence remains high within West Virginia. According to the American Diabetes Association, approximately 223,338 individuals (15.7% of the population) in the state are living with diabetes, and more than 10,000 new cases are diagnosed annually (ADA, n.d.). These statistics highlight the urgent need for improved preventive strategies within the region.
Evidence-based recommendations from the American Diabetes Association emphasize the importance of routine diabetic foot assessments and regular glycemic monitoring through HbA1c testing. Additionally, telemedicine technologies have demonstrated effectiveness in improving patient access to healthcare services, especially for individuals living in remote or underserved areas (Hazenberg et al., 2020). When patients receive timely guidance and monitoring through digital platforms, they are more likely to manage diabetes effectively and prevent complications such as diabetic foot ulcers.
Furthermore, implementing automated reminders within EHR systems can ensure healthcare providers conduct routine foot examinations and glycemic monitoring. Regular screening has been identified as a cost-effective strategy that reduces complications associated with diabetes (Zhao et al., 2023). Collectively, these changes are expected to enhance patient outcomes, reduce healthcare expenditures, and improve the quality of life for diabetic populations served by SWVHS.
Desired Outcomes
The proposed change aims to achieve several key outcomes that directly improve diabetes management and patient safety. The primary goal is the prevention of diabetic foot complications, including infections, delayed wound healing, ulcer formation, and limb amputation. Early identification of risk factors allows healthcare providers to implement timely interventions that prevent the progression of these complications.
Another expected outcome involves expanding healthcare access to underserved populations through telehealth services. Telemedicine platforms enable healthcare professionals to monitor patient conditions remotely, provide medical advice, and evaluate foot conditions through digital consultations. Studies have shown that telehealth programs can reduce ulcer occurrence, accelerate wound healing, and decrease the need for frequent hospital visits (Hazenberg et al., 2020).
Additional outcomes include improved glycemic control and enhanced patient engagement in self-care activities. The integration of EHR-based alerts will notify patients and clinicians when routine examinations or HbA1c tests are required, ensuring that care remains consistent and proactive. Early detection of elevated blood glucose levels is particularly important because poor glycemic control significantly increases the risk of diabetic foot complications (Casadei et al., 2021).
Financial support for implementing these changes may come from several sources, including Medicaid programs, private insurance coverage, federal healthcare funding, and hospital resources. However, potential barriers may arise during implementation. These challenges include the cost of integrating new technologies into existing EHR systems and possible resistance from healthcare staff who may perceive additional screening requirements as increasing their workload.
Successful implementation will require adequate financial resources, strong leadership support, and collaboration among interdisciplinary healthcare professionals.
Health Care System Comparative Analysis
Examining diabetic foot care practices in international healthcare systems provides valuable insights that can inform improvements at SWVHS. Two notable systems—the United Kingdom’s National Health Service (NHS) and the Australian healthcare system—have implemented evidence-based strategies that significantly reduce diabetic foot complications.
The NHS follows guidelines established by the National Institute for Health and Care Excellence (NICE). These guidelines emphasize preventive strategies such as routine foot assessments, patient education, and coordinated multidisciplinary care involving endocrinologists, diabetes specialists, podiatrists, and nurses. This collaborative approach ensures that patients receive comprehensive care and early intervention for potential complications (NHS, n.d.).
Similarly, the Australian healthcare system follows guidelines developed by the National Health and Medical Research Council (NHMRC). These guidelines recommend annual foot assessments for patients at low risk and more frequent monitoring for high-risk individuals. Australia has also successfully integrated telehealth services, particularly in remote regions where access to healthcare facilities is limited (Kaminski et al., 2022).
The following table summarizes the comparison of these healthcare systems.
| Outcome Area | United Kingdom (NHS – NICE Guidelines) | Australian Healthcare System (NHMRC Guidelines) | U.S. Healthcare System (SWVHS) |
|---|---|---|---|
| Prevention of diabetic foot complications | Multidisciplinary care and routine foot screening reduce complications | Telehealth monitoring and guideline-based screening reduce risk of ulcers and DPN | Higher complication rates due to healthcare disparities and limited rural services |
| Access to healthcare services | Staff training and coordinated services improve care delivery in remote areas | Telehealth expands provider access and patient monitoring | Limited accessibility due to geographic barriers and resource constraints |
| Patient safety and outcomes | Patient education programs support self-care and glycemic control | Regular foot exams and patient education enhance disease management | Delayed diagnosis and limited screening lead to poorer outcomes |
This comparison highlights that structured guidelines, multidisciplinary teams, and telehealth services play a critical role in improving diabetic foot care outcomes.
Rationale for the Proposed Change
The proposed improvements for SWVHS are supported by evidence from both the NHS and Australian healthcare systems. Implementing staff training programs, adopting multidisciplinary care approaches, and integrating telehealth services can significantly enhance diabetic foot care management.
Guidelines developed by NICE and NHMRC emphasize preventive care strategies, including routine foot examinations, early detection of neuropathy, and patient education. These interventions reduce complications such as DPN and foot ulcers while promoting effective disease management.
Telehealth technology is particularly beneficial for rural healthcare systems because it enables real-time communication between patients and healthcare providers. Patients can receive medical guidance, monitoring, and follow-up care without traveling long distances to healthcare facilities (Hazenberg et al., 2020). Additionally, telehealth services encourage patients to engage in self-care practices, including daily foot inspections and blood glucose monitoring.
The multidisciplinary model further strengthens diabetic foot management by bringing together healthcare professionals from different specialties. Collaborative care improves treatment coordination, enhances patient education, and ensures that complications are addressed promptly (Choi et al., 2023).
Because SWVHS already possesses some telehealth infrastructure, implementing these changes is feasible. By adopting international best practices, the organization can improve patient safety, reduce healthcare disparities, and align its services with global standards of diabetic care.
Financial and Health Implications
Introducing telehealth services, multidisciplinary care teams, and EHR-based screening systems may require initial financial investment. However, these strategies offer significant long-term economic and health benefits.
In the short term, patients will gain improved access to healthcare services regardless of their geographic location. Increased monitoring and early detection will enhance patient safety and satisfaction. Over time, these interventions will reduce the frequency of severe diabetic complications, lowering hospitalization rates and healthcare expenditures.
Early detection of DPN and foot ulcers is particularly important because treating advanced complications is significantly more expensive. Preventive screening reduces the need for costly surgical procedures, rehabilitation, and long-term care (Felix et al., 2023). Telemedicine programs also empower patients to manage their conditions effectively, improving disease control and quality of life (Hazenberg et al., 2020).
Conversely, failing to implement these improvements may lead to increased rates of severe neuropathy and amputations. Such complications require extensive medical treatment and rehabilitation services, creating financial burdens for both healthcare institutions and patients. Research indicates that treatment costs for diabetic patients with foot ulcers are approximately five times higher than those without such complications (Felix et al., 2023).
Therefore, implementing these evidence-based interventions is essential for improving both patient outcomes and healthcare sustainability within SWVHS.
Conclusion
Improving diabetic foot care practices within the Southern West Virginia Health System is essential to reduce complications associated with diabetes. The integration of telehealth services, routine foot screening, and EHR-supported monitoring systems will strengthen preventive care and improve patient outcomes.
By adopting evidence-based strategies from international healthcare systems such as the NHS and Australian healthcare frameworks, SWVHS can significantly enhance its diabetes management programs. Telehealth services will also help reduce healthcare disparities by providing equal access to care for patients living in rural communities across West Virginia.
Ultimately, implementing these changes will improve quality of life for diabetic patients, reduce healthcare costs, and strengthen the effectiveness of the regional healthcare system.
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
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
NURS FPX 6218 Assessment 1 Proposing Evidence-Based Change
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
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 West Virginia. 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.
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. BMC Primary Care, 24(1). https://doi.org/10.1186/s12875-023-02027-3