Project LEAP of New Jersey: Lower extremity amputation prevention in persons with type 2 diabetes

Objective: To reduce type 2 diabetes-related lower extremity amputations (L EAs) in New Jersey through a statewide training program for primary care pr oviders at healthcare agencies in high-risk areas. Study Design: Project LEAP provided 27 1-day training workshops to 560 heal thcare professionals representing 85 organizations. The effect of training was evaluated based on a multiple-choice knowledge test, self-reported prac tice behaviors, and a medical records audit of practice behaviors, and pre- and postprogram LEA rates. Patients and Methods: We evaluated statistically significant differences in pre- and postprogram knowledge scores using Student's t-tests. We also eva luated providers' intentions to change clinical foot-care practices and com pared them with actual practices documented in medical records. We used ana lysis of variance to determine any statistically significant differences in pre- and postprogram LEA rates at various types of institutions. In additi on, we assisted facilities in the development of self-education programs co ntaining specific foot-care modules. Results: Participating providers were: 70.6% nurses, 7.8% physicians, 4.5% podiatrists, 4.2% dietitians, and 12.9% all others. Pre- and postprogram kn owledge scores increased by 12% (T=13.29; P<0.0001) and were maintained for 9 months (T=7.58; P<0.05). Provider intentions to change clinical practice behaviors correlated with self-reported practice changes 9 months postprog ram (r =.51; P<0.001). Medical record audits 1 year before and 9 months aft er training demonstrated marked improvement in foot-care practices in the f ollowing areas: (1) foot-care education given to patients by primary cave p roviders; 2) documentation of peripheral vascular disease; 3) documentation of patient preventive care practices; and 4) referrals to diabetes educato rs, orthopedists, podiatrists, and diabetologists. Education programs with specific foot-care components increased 10%. The overall incidence of pre- and posttraining LEAs did not change significantly but differed depending o n institution type. Hospitals and community healthcare centers were move li kely to show postprogram reductions in LEAs than nursing homes and rehabili tation centers. Conclusion: Institutionalization of a LEAP program resulted in improved pro vider knowledge and certain clinical practice behaviors. There was a trend toward an overall reduction in the number of LEAs at participating institut ions.