How Innovation and Partnership are Ending Diabetic Limb Loss at VA

Through innovative public-private partnerships, VA is reducing hospitalizations and diabetic amputations


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The Veterans Health Administration Innovation Ecosystem (VHA IE) is a leader in health care innovation, but it does not innovate alone. Using public-private partnerships, VHA IE draws in the best and brightest partners to solve challenges unique to the Veteran community. But what happens when an innovation shows value? How does VHA IE advance these promising solutions to change and save more Veteran lives?

VA’s groundbreaking partnership with Podimetrics is a great example. This partnership is led by Suzanne Shirley, VHA IE Director of Partnerships & Community Engagement and clinical social worker. The partnership, named The Initiative to End Diabetic Limb Loss at VA (TIEDLLV), supplies at-risk, diabetic Veterans with mats that use thermal imaging to measure the temperature of a Veteran’s foot. These mats can detect diabetic foot ulcers (DFUs) up to five weeks before they would normally present.

Veterans stand on the mat for 20 seconds each day, and their information is recorded and uploaded to the cloud. In the cloud, Podimetrics’ advanced artificial intelligence (AI) system analyzes it for signs of DFUs. The preliminary impact was positive, with reductions in hospital admissions and amputations.

Success, however, does not mean innovation like this stands still, and Shirley – alongside Podimetrics CEO, Jon Bloom, and VA National Podiatry Chief, Dr. Jeffrey Robbins – saw a way to make the system work better for both Veterans and VA.

A massive challenge, impacting thousands of Veteran lives

A DFU can very easily lead to an amputation or even death for a diabetic Veteran. The most at-risk Veterans face a 5-year mortality rate of 43% after developing their first DFU. With 25 percent of Veterans suffering from diabetes, DFUs are a major concern for VA. Last year, VA treated 75,000 DFUs, which accounted for more than 80% of non-traumatic amputations in VA, resulting in a cost of more than $3.2 billion.

Catching these foot ulcers early, before they are even visible, can save limbs and lives. It is why VA has worked aggressively to spread remote temperature monitoring as a standard practice. Through the creation of a national task force, Shirley tested and scaled the devices across VA. This task force completed exhaustive quality assurance (QA) chart reviews, research investigations, and educational sessions. The team also streamlined the purchasing guidelines and redesign of preventative care models.

“I saw countless Veterans lose their lives because of complications from diabetic foot ulcers,”said Shirley. “I knew we had to tackle this problem and find a solution. Once we saw the results from the use of remote temperature monitoring, we worked to make sure that it became a part of VA’s diabetic care.”

Still, the program had challenges that needed to be fixed for it to scale across VA.

Innovating and adapting to improve Veteran care

By moving from treatment to prevention, VA providers can spend more time when it matters most and improve patient outcomes while reducing their workload. Despite the promise of preventative, tech-enabled services, the challenge in scaling is adapting such systems to current VA care models. Without adaptation, a technical solution like this is unable to fall into existing infrastructure, restricting funding and access to this technology.

Through extensive research and collaboration, TIEDLLV began integrating into VA’s telehealth podiatry services. Thanks to this effort, the program is now at over 40 VA medical centers, with mats being prescribed to Veterans who are at the highest risk for amputation.

The results for Veterans are nothing short of staggering. Early QA data at participating sites has suggested that the Podimetrics system results in a near elimination of all severe ulcers, use of expensive graft product, and major amputations. In addition, hospitalizations dropped by 92%. The implications to diabetic Veteran care are dramatic.

As the program prepares to go national, VHA IE is engaging with partners to see how it can enhance and scale other impactful solutions to serve our Veterans. Through partnerships, VHA IE can combine the best of the private and public sectors to change and save Veterans lives.

Author

Matthew Razak

Matthew Razak supports VA as a contractor with Atlas Research, a Washington, D.C.-based consulting firm providing strategic advisory and applied research services to federal health and social service agencies. Matt has been working with VA for the past six years supporting social media and communication efforts.

Comments

  1. Michael William Crowley    

    I am currently rated 80% disabled by the VA. I had a recent Nerve Conduction Study which showed significant progression of my polyneuropathy . If the detection mats for early ulcer diagnosis are available at the Charleston VA I would like to have one.

  2. John Joseph Danehy    

    I am a disabled vet with diabetes. also retired with 30 yrs service, 82 yrs and I am covered medically by M/C and TFL. I have never been to VA except years ago when I underwent VA physical to determine my percent of disability, all my medical for the past 35 yrs have been with private providers. If you think I’m eligible for this system, (constant numbness and pain in toes) does the VA office in Elgin Illinois have this system in house. Please advise. John J. Danehy, CMSgt Ret USAF.

  3. Ron Short    

    Does American lake VA in lakewood wa. Have the Matt’s, if so how can I get one!

    1. suzanne shirley    

      Yes sir! Please email me at Suzanne.Shirley@va.gov for more information to see if you could benefit from this system.

  4. Michael R Harrelson    

    Michael R Harrelson

    I’m in North Carolina does the Durham V A ave this program

    1. suzanne shirley    

      Yes sir! Please email me at Suzanne.Shirley@va.gov for more information to see if you could benefit from this system.

  5. Max Hammer    

    I’m currently dealing with a reoccurring DFU. I have been dealing with them for several years now. Something like this would be a life saver to many Vets.

    1. suzanne shirley    

      I’m sorry to hear you’re dealing with reoccuring DFU. Please email me at Suzanne.Shirley@va.gov for more information to see if you could benefit from this system.

  6. Gene Raymond Thompson    

    also if you need people to test the product/procedure I am open and always available.

  7. Gene Raymond Thompson    

    I am a Disabled Vet. with Diabetes my feet are numb all the time I am constantly tripping over my own feet and my feet are now always as cold as ice. Yes I would love to try it out before it is too late what do I have to do or where do I have to go? You tell me and I will be there!

    1. suzanne shirley    

      I’m sorry to hear that. Please email me at Suzanne.Shirley@va.gov for more information to see if you could benefit from this system.

  8. David Swomley    

    Veteran w/diabetes. How can I qualify for care? I live in Indonesia.

    1. suzanne shirley    

      David, if you receive care at a VA medical center, you may qualify to receive this system. Feel free to email me at suzanne.shirley@va.gov.

  9. Howard Griffith    

    Does Marion VA Hospital have this would like to give it a try I’m. Vietnam Vet with diabetes

    1. suzanne shirley    

      Yes sir! Please email me at Suzanne.Shirley@va.gov for more information to see if you could benefit from this system.

    2. suzanne shirley    

      All VA Medical Centers across the country can prescribe this system. Please email me at Suzanne.Shirley@va.gov for more information to see if you could benefit from this system.

  10. Ronald E Harris    

    I am a vet with diabetes would like to know how to become involved in this

    1. suzanne shirley    

      Please email me at Suzanne.Shirley@va.gov for more information to see if you could benefit from this system.

  11. louis yarbrough    

    MY FEET ARE IN BAD DUE TO DIABETES I NEED LOTS OF HELP MY V.A. OUTSOURCE FOOT DOCTOR IS ALREADY VERY CONCERNED WITH MY CONDITION.

    1. suzanne shirley    

      I’m sorry to hear that, please email me at suzanne.shirley@va.gov to see learn more about this system.

  12. LARRY D THOMAS    

    I live in Houston, Texas, how do I get to try one of these matts out for myself. Do I have to get on a list and, if so, how do I do that?

    1. suzanne shirley    

      Please email me at Suzanne.Shirley@va.gov for more information to see if you could benefit from this system.

  13. Howard Griffith    

    I’m a vet with diabetes would like to try it

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