Evaluation of the clinical and economic burden of diabetic foot ulcers in Singapore and outcome improvement through health systems innovations

Abstract

This mixed-methods research aims to evaluate the burden of diabetic foot ulcer (DFU) disease in Singapore and improve outcomes through health systems innovation of coordinated multi-disciplinary team (MDT) care between primary and tertiary care. Our approach involved retrospective observational studies across hospital and healthcare clusters, evaluating DFU incidence, associated amputation rates, metabolic control and direct healthcare costs. Furthermore, we qualitatively identified care gaps and optimized guidelines-based MDT care between primary and tertiary care using a prospective healthcare cluster-wide health systems innovation. We conducted a quantitative evaluation of the outcomes of the prospective treatment cohort (2020–2022, n=4,660) and propensity score matched (PSM) against a control group (2016–2017, n=5,462). Our findings revealed a heavy clinical and economic burden of DFU disease in Singapore. We demonstrated a significant improvement in amputation-free survival, metabolic control and direct healthcare cost savings by implementing a health systems innovation of coordinated MDT care between primary and tertiary care. In addition, we demonstrated the feasibility and potential benefits of a patient-owned digital health application for DFU monitoring, using both qualitative and quantitative approaches.