Facility-level variations in patient-reported footcare knowledge sufficiency: implications for diabetes performance measurement.

Abstract

To evaluate medical center variation in self-reported knowledge of footcare practices by veterans at high risk for lower extremity complications. We utilized a previously validated footcare-specific survey from 772 (44% response rate) veterans with diabetes and high-risk foot conditions at eight Veterans Administration facilities that contained items on knowledge of basic (such as how to inspect feet) and specialized self-foot care practices (such as cutting nails and shaving calluses). Linear regression models were used to evaluate facility-level variation in unadjusted and adjusted education (controlling for age, schooling, general, and foot health). Participants' average age was 67 years, 94% were male and 34% had 13 years of education. The mean facility basic knowledge score on a four-point ordinal scale was 3.1 (range: 2.9-3.3), where 1=no knowledge and 4=enough knowledge. The specialized knowledge score, using the same scale, was 2.52 (range: 2.2-2.8). There were significant (p<0.005) differences among facilities in both unadjusted and adjusted basic and specialized footcare knowledge. Patient self-reported footcare knowledge was suboptimal and significantly varied across medical centers with and without adjustment for foot-risk factors, general health, and demographic factors.