A comparison of diabetic foot ulcer patients managed in VHA and non-VHA settings

Objective: To compare patients with diabetes and new onset foot ulcers trea ted in Veterans Health Administration (VHA) and non-VHA settings. Methods: The treatment of patients with new onset diabetic foot ulcers was prospecti vely monitored in three VHA and three non-VHA hospitals and outpatient sett ings until ulcer healing, amputation, or death. Results: Of the 302 individ uals enrolled in this study, 47% were veterans receiving VHA care. There: w ere no significant differences between veterans and nonveterans in baseline wound classification, diabetes severity, or comorbid conditions. Veterans received significantly fewer sharp debridements, total contact casts, and c ustom inserts than their nonveteran counterparts, and they had significantl y more x-rays, local saline irrigations, IV antibiotics, and prescriptions for bed rest. The percentage of amputations was higher in veterans but did not achieve statistical significance. Conclusions: Many commonly held stere otypes of veteran men were not found. Veterans and nonveterans with foot ul cers were similar in terms of health and foot history, diabetes severity, a nd comorbid conditions. There was considerable variation in treatment of di abetic foot ulcers between VHA and non-VHA care. Yet this variation did not result in statistically significant differences in ulcer outcomes.