Background

Diabetic Foot Infections (DFI) are a common and often challenging clinical condition. The prevalence of diabetes continues to increase and a quarter of all patients with diabetes will develop foot ulceration, the primary impetus for infection.1 Ranging from mild to severe limb- and life threatening infections, DFI are a common cause for hospitalization. As a result, diabetes is the most common cause of non-traumatic amputation, and approximately 1% of people with diabetes suffer a lower limb amputation.2.

The complex nature of DFI requires a team-based approach. DFIs occur in the context of hyperglycemia, requiring Internal Medicine and Endocrinology specialists to optimize glycemic control. They are frequently poly-microbial and require intravenous antibiotic therapy for extending durations, requiring Infectious Disease input and follow-up. Skilled wound care is required for ensured healing. Finally, they are also surgical in nature warranting Surgery or Podiatry consultation with possible debridement or amputation and resulting postoperative care.

Smaller health care facilities and rural hospitals may lack the specialty care and care coordination requirements to address the complex nature of DFI. In particular, Infectious Disease specialists may not be readily available to contribute to vital parts of the care continuum in general, and, in particular, bridge care from inpatient disease stabilization and surgical management to outpatient antibiotic infusion and ongoing wound care management.

60%

Amputations are due to Diabetes

15%

Osteomyelitis occurs in DFI

28%

3 year mortality for DFI patients

The Solution: Beam Healthcare’s Infectious Disease Telemedicine Service Line

At Beam Healthcare, we employ telemedicine Infectious Disease specialists to evaluate moderate to severe DFIs hospitalized in areas without access to such specialty care. Patents admitted for DFI are stabilized by hospitalists (frequently via telemedicine) and undergo surgical evaluation. After stabilization and gaining microbiological data, Infectious Disease telemedicine specialists evaluate patients as an inpatient consult. Determining appropriate antibiotic selection, duration, and required follow-up Infectious Disease telemedicine care then effortlessly transitions to outpatient and infusion center management. Additionally, Beam Healthcare coordinates outpatient Infectious Disease telemedicine follow-up with subsequent wound care visits to optimize both care coordination and retention.

"Due to his (Dr. Scholtz - Tele-ID) clinical thinking he recognized that one of our wound patients required immediate surgical intervention and arranged transport to a higher level of care."

Summary

As outlined in the case study above, Beam Healthcare provides clinical telemedicine services that deliver vital components of team-based multi-specialty care. For DFI, these services provide direct care management, specialty guidance, efficient transitions of care, and local care retention. The results reflect Beam’s ongoing commitment to creating enduring partnerships with clients and community members. Opening the door to accessing multiple specialties, Beam Healthcare offers scalable telemedicine models that have seamless inpatient and outpatient functionality without high overhead. Additionally, our model answers the call for redefining care delivery for diabetic foot management in light of the COVID-19 pandemic by promoting infection control and high-value clinical management.

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