Lower Extremity Amputation Prevention Project (LEAP)

Project Background and Goals:

The Lower Extremity Amputation Prevention (LEAP) Program is an intervention designed to prevent lower extremity amputations in diabetics. The project is currently implemented in four Community/Migrant Health Centers (C/MHCs) in New York City, New Jersey and Puerto Rico. The "Centers of Excellence" (CoE) will then be used as model training sites for other C/MHCs. The LEAP project combines provider and patient education in foot care with the use of a simple diabetic foot screening examination using a specialized inexpensive tool, the monofilament, to detect loss of protective sensation in the feet, with a scoring system to identify persons with diabetes who are at elevated risk for developing foot disease, and office system modifications to assure implementation and appropriate referrals.

Assessment of provider and patient outcomes will measure changes in foot care as determined by frequency and quality of documented foot exams and referrals, whether there are improved diabetic outcomes measured by decreased incidence of foot ulcers and amputations, change in overall health knowledge and awareness by diabetics, and changes in provider and patient knowledge, attitudes and behaviors. Basic information about LEAP Project is also being mailed to C/MHCs not participating in the program.

The implementation will be assessed in three ways:

1. Detailed prospective data collection covering the baseline period through the first two years at the four CoEs.

2. Using the same data collection methods, comparison of the same two year period of matched patients and providers at four similar C/MHCs not participating in the initial implementation, but which did receive LEAP mailing, to measure whether changes are greater with active implementation.

3. Prospective survey of the general population in the region to measure the general changes in diabetic foot care practice occurring over the same time period.