{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:23:14Z","timestamp":1793726594244,"version":"4.6.1"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:00:00Z","timestamp":1784332800000},"content-version":"vor","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>To address the systemic financial and equity burdens of preventable diabetes-related lower-extremity amputations, this perspective evaluates current structural failures in US healthcare financing and proposes a scalable, prevention-oriented framework. Current fee-for-service models consistently reimburse expensive disease deterioration while neglecting early surveillance. Meanwhile, omitting preventive foot metrics from federal quality frameworks renders early intervention organizationally invisible. In response, this analysis incorporates data from a peer-reviewed, 5-year implementation study within a medically complex population using low-overhead, multilingual, digital patient education and risk-stratified surveillance. This low-friction intervention model achieved a diabetic foot ulcer rate of 2.8% and a major amputation rate of 0.43%, significantly outperforming the federal Healthy People 2030 benchmark of 0.55%. To replicate these results nationally, public payers must integrate risk-stratified podiatric surveillance into core quality reporting frameworks, expand reimbursement codes for asynchronous digital education, and formally classify patient-centered education as vital health infrastructure. Such policy prioritization will mitigate profound health disparities, reduce avoidable public spending, and preserve patient mobility.<\/jats:p>","DOI":"10.1093\/haschl\/qxag190","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:43:27Z","timestamp":1784288607000},"source":"Crossref","is-referenced-by-count":1,"title":["Underinvesting in prevention: the costly blind spot in US diabetes care"],"prefix":"10.1093","volume":"4","author":[{"given":"Paul Y","family":"Han","sequence":"first","affiliation":[{"name":"Department of Diabetes, Endocrinology & Metabolism, City of Hope National Medical Center , Duarte, CA 91010 ,","place":["United States"]},{"name":"Department of Surgery, South Coast Global Medical Center, Santa Ana, CA 92704 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,18]]},"reference":[{"key":"2026073005170801100_qxag190-B1","volume-title":"Prevalence of Diabetes, Diabetic Foot Ulcer, and Lower-Extremity Amputation Among Medicare Beneficiaries, 2006 to 2008 [Internet]","author":"Margolis","year":"2011"},{"issue":"24","key":"2026073005170801100_qxag190-B2","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic foot ulcers and their recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N Engl J Med"},{"issue":"3","key":"2026073005170801100_qxag190-B3","doi-asserted-by":"publisher","first-page":"651","DOI":"10.2337\/dc13-2176","article-title":"Burden of diabetic foot ulcers for Medicare and private insurers","volume":"37","author":"Rice","year":"2014","journal-title":"Diabetes Care"},{"key":"2026073005170801100_qxag190-B4","volume-title":"Health Center Program Uniform Data System (UDS) Data Overview [Internet]","author":"US Health Resources and Services Administration (HRSA)"},{"issue":"2","key":"2026073005170801100_qxag190-B5","doi-asserted-by":"publisher","first-page":"25108","DOI":"10.7547\/25-108","article-title":"A novel diabetic limb preservation initiative using symptom-focused education and coordinated podiatric care","volume":"116","author":"Han","year":"2026","journal-title":"J Am Podiatr Med Assoc"},{"key":"2026073005170801100_qxag190-B6","volume-title":"Merit-based Incentive Payment System (MIPS) [Internet]","author":"Centers for Medicare & Medicaid Services (CMS)"},{"key":"2026073005170801100_qxag190-B7","volume-title":"HEDIS and Performance Measurement [Internet]","author":"National Committee for Quality Assurance (NCQA)"},{"key":"2026073005170801100_qxag190-B8","volume-title":"Healthy People 2030: Reduce the rate of foot and leg amputations in adults with diabetes (D-08) [Internet]","author":"US Department of Health and Human Services (HHS)"}],"container-title":["Health Affairs Scholar"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/advance-article-pdf\/doi\/10.1093\/haschl\/qxag190\/69262253\/qxag190.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/7\/qxag190\/69262253\/qxag190.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article-pdf\/4\/7\/qxag190\/69262253\/qxag190.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:17:15Z","timestamp":1785403035000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/healthaffairsscholar\/article\/doi\/10.1093\/haschl\/qxag190\/8737001"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":8,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,3]]}},"URL":"https:\/\/doi.org\/10.1093\/haschl\/qxag190","relation":{},"ISSN":["2976-5390"],"issn-type":[{"value":"2976-5390","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7]]},"article-number":"qxag190"}}