Quality of Health Care

High-quality health care for persons with diabetes is integral to preventing foot complications and reducing major amputations. Understanding “quality” in the care of the diabetic foot requires a basic understanding of the components of health care quality measurement, both generally and in diabetes specifically. Current guideline-based standards of preventive care and treatment of diabetic foot ulcers provide an important foundation for identifying and addressing existing gaps between the standard of care and care delivery. However, a focus on meeting risk factor control targets may ignore important clinical and patient-centered outcomes, including recurrent hospitalizations, patient satisfaction, and quality of life. Additionally, the geographic and socioeconomic context in which care disparities persist is particularly relevant to efforts to improve the equity and quality of diabetic foot care. This chapter will provide an overview of care quality definitions and metrics, with a focus on diabetes-related quality indicators relevant to diabetic foot and limb care. Data on the current state of national health care quality in diabetic foot care, evidence-based models for quality improvement, and best practices for comparative effectiveness research to improve quality and address disparities in quality will also be reviewed.