To improve nationwide diabetic foot care, auditing and accreditation is encouraged.
Diabetes Feet Australia is making our first steps on this long path, for example with the minimum dataset (https://www.diabetesfeetaustralia.org/for-researchers/australian-diabetic-foot-ulcer-minimum-dataset-dictionary/). Compared to Scotland, Germany and Belgium, it is clear we have a long way to go. These three countries are setting standards for us all. Prof Leese and Dr Stang share their experience and ideas on the clinical processes and outcome measures to use when trying to monitor and improve national diabetic foot care. Apart from the obvious important outcomes such as ulcer healing (the most important one) and amputation rates, their remarks on the caution required to monitor amputation rates as well as the importance of including rehabilitation services give some food for thought.
The German model, backed by government legislation, started with 30 consecutive patients and now has over 24,000 cases registered, with 68 inpatient and 206 outpatient accredited facilities participating. The Belgium model used support from two patient organizations to negotiate criteria for accreditation of diabetic foot centres with the national reimbursement system. This has led to a current recognition of 36 diabetic foot centres, all collecting data on their processes and outcomes of diabetic foot care.
Although both papers describe the burden that comes with national auditing and accreditation, they both show us what can be achieved nationally when all major stakeholders decide to work together to improve diabetic foot care and engage clinicians and patients to work in the challenging yet rewarding tasks that comes with collecting national diabetic foot data. An inspiration for where we would like to go in Australia.