{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:46:12Z","timestamp":1791215172574,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,10,5]],"date-time":"2022-10-05T00:00:00Z","timestamp":1664928000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000361","name":"Diabetes UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000361","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>This cohort study investigates the extent to which variation in ulcer healing between services can be explained by demographic and clinical characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The National Diabetes Foot Care Audit collated data on people with diabetic foot ulcers presenting to specialist services in England and Wales between July 2014 and March 2018. Logistic regression models were created to describe associations between risk factors and a person being alive and ulcer\u2010free 12\u2009weeks from presentation, and to investigate whether variation between 120 participating services persisted after risk factor adjustment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 27,030 people with valid outcome data, 12,925 (47.8%) were alive and ulcer\u2010free at 12\u2009weeks, 13,745 (50.9%) had an unhealed ulcer and 360 had died (1.3%). Factors associated with worse outcome were male sex, more severe ulcers, history of cardiac or renal disease and a longer time between first presentation to a non\u2010specialist healthcare professional and first expert assessment. After adjustment for these factors, four services (3.3%) were more than 3SD above and seven services (5.8%) were more than 3SD below the national mean for proportions that were alive and ulcer\u2010free at follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions\/Interpretations<\/jats:title><jats:p>Variation in the healing of diabetic foot ulcers between specialist services in England and Wales persisted after adjusting for demographic characteristics, ulcer severity, smoking, body mass index and co\u2010morbidities. We conclude that other factors contribute to variation in healing of diabetic foot ulcers and include the time to specialist assessment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.14959","type":"journal-article","created":{"date-parts":[[2022,9,17]],"date-time":"2022-09-17T08:04:26Z","timestamp":1663401866000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Impact of case\u2010mix adjustment on observed variation in the healing of diabetic foot ulcers at 12\u2009weeks using data from the National Diabetes Foot Care Audit of England and Wales: A cohort study"],"prefix":"10.1111","volume":"40","author":[{"given":"Arthur C.","family":"Yelland","sequence":"first","affiliation":[{"name":"NHS Digital Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Meace","sequence":"additional","affiliation":[{"name":"NHS Digital Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Knighton","sequence":"additional","affiliation":[{"name":"NHS Digital Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Holman","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular and Medical Sciences University of Glasgow Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7824-2569","authenticated-orcid":false,"given":"Sarah H.","family":"Wild","sequence":"additional","affiliation":[{"name":"Usher Institute University of Edinburgh Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Michalowski","sequence":"additional","affiliation":[{"name":"NHS Digital Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bob","family":"Young","sequence":"additional","affiliation":[{"name":"National Diabetes Audit Diabetes UK London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1744-7576","authenticated-orcid":false,"given":"William J.","family":"Jeffcoate","sequence":"additional","affiliation":[{"name":"Nottingham University Hospitals Trust Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,10,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-004-1584-3"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.5.860"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc11-0807"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-012-2468-6"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/SO140-6736(17)32401\u201332407"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2013.03.008"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-021-05440-4"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-008-0940-0"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9061780"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3273"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.2400"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-2367"},{"key":"e_1_2_10_14_1","unstructured":"National Diabetes Audit.Report 2 Complications and Mortality 2017\u201018. 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