Higher rates of all-cause mortality and resource utilization during episodes-of-care for diabetic foot ulceration

Brian J. Petersen, Walter T. Linde-Zwirble, Tze Woei Tan, Gary M. Rothenberg, Simon J. Salgado, Jonathan D. Bloom, David G. Armstrong

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Aims: Our primary objective was to determine whether all-cause rates of mortality and resource utilization were higher during periods of diabetic foot ulceration. In support of this objective, a secondary objective was to develop and validate an episode-of-care model for diabetic foot ulceration. Methods: We evaluated data from the Medicare Limited Data Set between 2013 and 2019. We defined episodes-of-care by clustering diabetic foot ulcer related claims such that the longest time interval between consecutive claims in any cluster did not exceed a duration which was adjusted to match two aspects of foot ulcer episodes that are well-established in the literature: healing rate at 12 weeks, and reulceration rate following healing. We compared rates of outcomes during periods of ulceration to rates immediately following healing to estimate incidence ratios. Results: The episode-of-care model had a minimum mean relative error of 4.2% in the two validation criteria using a clustering duration of seven weeks. Compared to periods after healing, all-cause inpatient admissions were 2.8 times more likely during foot ulcer episodes and death was 1.5 times more likely. Conclusions: A newly-validated episode-of-care model for diabetic foot ulcers suggests an underappreciated association between foot ulcer episodes and all-cause resource utilization and mortality.

Original languageEnglish (US)
Article number109182
JournalDiabetes Research and Clinical Practice
StatePublished - Feb 2022


  • Amputations
  • Diabetic foot ulcers
  • Episodes of care
  • Hospitalizations
  • Prevention
  • Resource utilization

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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