ArticleJournal of foot and ankle research2020
Expect delays: poor connections between rural and urban health systems challenge multidisciplinary care for rural Americans with diabetic foot ulcers.
Article in Journal of foot and ankle research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 38 citations in OpenAlex.
- Patient-perceived and practitioner-perceived barriers to accessing foot care services for people with diabetes mellitus: a systematic literature review.Journal of foot and ankle research · 2022Pooled it
- Treatment Delay in Patients With Diabetes-Related Foot Ulcers: A Walker and Avant Concept Analysis.Nursing & health sciences · 2026Review
- Knowledge, attitudes and practices of nurses regarding diabetic foot ulcer care at Sunyani teaching hospital, Ghana: a cross-sectional study.BMC nursing · 2026Article
- Benefits of Multi-Disciplinary Limb Preservation Teams.Clinics in podiatric medicine and surgery · 2026Review
- Complicated foot ulcers and high treatment costs in rural type 2 diabetic patients in vietnam: impact of infections on hospital stays.Cost effectiveness and resource allocation : C/E · 2026Article
- A randomized controlled trial of patient navigators for post-hospital discharge diabetic foot ulcer care: the Comprehensive Assistance and Resources for Effective Diabetic Foot Navigation (CARE-D-Foot-Nav) study protocol.medRxiv : the preprint server for health sciences · 2025Article
- Incidence of diabetic foot ulcer and its predictors among adult diabetes patients in Northern Ethiopia: a retrospective cohort study.Scientific reports · 2025Article
- Diagnostic Accuracy of Microsoft's Copilot Artificial Intelligence in Chronic Wound Assessment: A Comparative Study.Plastic and reconstructive surgery. Global open · 2025Article
- Nanomanaging Chronic Wounds with Targeted Exosome Therapeutics.Pharmaceutics · 2025Review
- Association between Regional Market Competition and Early Femoropopliteal Interventions for Claudication.Annals of vascular surgery · 2025Article
- Evaluation and Management of Diabetes-related Foot Infections.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- From Identity to Ambugity: Exploring Interprofessional Collaboration Opportunities for Pharmacists in Rural and Remote Australia.Pharmacy (Basel, Switzerland) · 2023Article
- Association of rurality and identifying as black with receipt of specialty care among patients hospitalized with a diabetic foot ulcer: a Medicare cohort study.BMJ open diabetes research & care · 2023Article
- Using the National Institute on Minority Health and Health Disparities framework to better understand disparities in major amputations.Seminars in vascular surgery · 2023Review
- Associations between specialty care and improved outcomes among patients with diabetic foot ulcers.PloS one · 2023Article
- A versatile, bioengineered skin reconstruction device designed for use in austere environments.Frontiers in bioengineering and biotechnology · 2023Article
- Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers.Diabetes care · 2023Review
- Racial Disparities in Health Care With Timing to Amputation Following Diabetic Foot Ulcer.Diabetes care · 2022Article
- A qualitative study of barriers to care-seeking for diabetic foot ulceration across multiple levels of the healthcare system.Journal of foot and ankle research · 2022Article
- Association of Race, Ethnicity, and Rurality With Major Leg Amputation or Death Among Medicare Beneficiaries Hospitalized With Diabetic Foot Ulcers.JAMA network open · 2022Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
backgroundRural Americans with diabetic foot ulcers (DFUs) face a 50% increased risk of major amputation compared to their urban counterparts. We sought to identify health system barriers contributing to this disparity.
methodsWe interviewed 44 participants involved in the care of rural patients with DFUs: 6 rural primary care providers (PCPs), 12 rural specialists, 12 urban specialists, 9 support staff, and 5 patients/caregivers. Directed content analysis was performed guided by a conceptual model describing how PCPs and specialists collaborate to care for shared patients.
resultsRural PCPs reported lack of training in wound care and quickly referred patients with DFUs to local podiatrists or wound care providers. Timely referrals to, and subsequent collaborations with, rural specialists were facilitated by professional connections. However, these connections often were lacking between rural providers and urban specialists, whose skills were needed to optimally treat patients with high acuity ulcers. Urban referrals, particularly to vascular surgery or infectious disease, were stymied by 1) time-consuming processes, 2) negative provider interactions, and 3) multiple, disconnected electronic health record systems. Such barriers ultimately detracted from rural PCPs' ability to focus on medical management, as well as urban specialists' ability to appropriately triage referrals due to lacking information. Subsequent collaboration between providers also suffered as a result.
conclusionsPoor connections across rural and urban healthcare systems was described as the primary health system barrier driving the rural disparity in major amputations. Future interventions focusing on mitigating this barrier could reduce the rural disparity in major amputations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.