Diabetes-related amputations represent a major preventable health risk for patients living with diabetes and lower extremity limb loss in particular is one of the most devastating events in a patient’s life, with five-year mortality approaching 70% and even higher in the population of patients LA Health Services serves. In response, Health Services announces the formation of a new Health Services workgroup targeting the epidemic of avoidable diabetes-related amputations. Led by a team of international experts in diabetes-related limb care at Rancho Los Amigos, Dr. David Armstrong (Podiatry) and Dr. Tze-Woei Tan (Vascular Surgery), with support from specialty leaders in podiatry, vascular surgery, rehabilitation, primary care and inpatient/emergency services across Health Services facilities, the Health Services Limb Preservation Workgroup is leading Health Services’ strategy to provide innovative and effective diabetic foot care across Los Angeles County.

The Health Services Limb Preservation workgroup will expand on the groundbreaking diabetic limb care model developed by Dr. Armstrong at Health Services’ own Rancho Los Amigos National Rehabilitation Center, which was named among US News and World Report’s “Best Hospitals” earlier this year, to improve both acute diabetic foot care as well as to address care gaps in chronic disease management, patient surveillance, and care coordination. The heart of the model is composed of the “Hot Foot” line, a triage program which triggers urgent evaluation of diabetic foot infections by podiatry, vascular surgery and infectious disease physicians at the point of care to provide rapid, organized multidisciplinary limb preservation care, and the “Toe, Flow, and Go” model which transitions patients with acute diabetic foot infections to specialists in podiatry, surgery and rehabilitation services in the ambulatory setting to improve chronic disease management and improve patient functionality to reduce recurrence. Dr. Armstrong’s research on this model indicates that the implementation of the “Hot Foot” line and the “Toe, Flow and Go” model reduce high level amputations by more than 50% and increase ulcer free days by even more, leading to healthier and more productive patients. Preliminary data on the implementation of these programs at Health Services indicate they have led to an improvement in diabetic limb care outcomes.

Despite the challenges facing patients with diabetes, the future is bright for diabetic limb preservation efforts across Los Angeles County and beyond. The Health Services Limb Preservation workgroup is also partnering with national and regional organizations, including the American Limb Preservation Society and the Southwestern Academic Limb Salvage Alliance to develop tools, educational programs, and awareness around diabetic foot care to its network of providers and members. Dr. Tan and his research team at the University of Southern California (USC) are also actively pursuing projects to evaluate how innovative digital technologies and virtual care strategies can provide more effective care for Health Services patients at risk of diabetes-related limb loss. Through these efforts, the Health Services Limb Preservation workgroup is furthering Health Services’ strategic initiatives to improve population health and deliver high quality, patient-centered care to improve chronic disease management and enhance patient’s long-term health and wellness by reducing unnecessary amputations and the social inequities that underlie them.

For additional information on the limb preservation program, reach out to: Bahar Basseri at BBasseri@dhs.lacounty.gov