{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:09:58Z","timestamp":1740146998166,"version":"3.37.3"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["CIN 13-402"],"award-info":[{"award-number":["CIN 13-402"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>We assessed equity in the uptake of remote foot temperature monitoring (RTM) for amputation prevention throughout a large, integrated US healthcare system between 2019 and 2021, including comparisons across facilities and between patients enrolled and eligible patients not enrolled in RTM focusing on the Reach and Adoption dimensions of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Material and methods<\/jats:title>\n<jats:p>To assess whether there was equitable use of RTM across facilities, we examined distributions of patient demographic, geographic, and facility characteristics across facility RTM use categories (e.g., no RTM use, and low, moderate, and high RTM use) among all eligible patients (n = 46,294). Second, to understand whether, among facilities using RTM, there was equitable enrollment of patients in RTM, we compared characteristics of patients enrolled in RTM (n = 1066) relative to a group of eligible patients not enrolled in RTM (n = 27,166) using logistic regression and including all covariates.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>RTM use increased substantially from an average of 11 patients per month to over 40 patients per month between 2019 and 2021. High-use RTM facilities had higher complexity and a lower ratio of patients per podiatrist but did not have consistent evidence of better footcare process measures. Among facilities offering RTM, enrollment varied by age, was inversely associated with Black race (vs. white), low income, living far from specialty care, and being in the highest quartiles of telehealth use prior to enrollment. Enrollment was positively associated with having osteomyelitis, Charcot foot, a partial foot amputation, BMI\u226530 kg\/m<jats:sup>2<\/jats:sup>, and high outpatient utilization.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>RTM growth was concentrated in a small number of higher-resourced facilities, with evidence of lower enrollment among those who were Black and lived farther from specialty care. Future studies are needed to identify and address barriers to uptake of new interventions like RTM to prevent exacerbating existing ulceration and amputation disparities.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0301260","type":"journal-article","created":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T17:40:16Z","timestamp":1711993216000},"page":"e0301260","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing equity in the uptake of remote foot temperature monitoring in a large integrated US healthcare system"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4247-8286","authenticated-orcid":true,"given":"Alyson J.","family":"Littman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4013-716X","authenticated-orcid":true,"given":"Andrew K.","family":"Timmons","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth T.","family":"Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne","family":"Shirley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Robbins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernest","family":"Moy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,4,1]]},"reference":[{"key":"pone.0301260.ref001","article-title":"Prevalence of and trends in diabetes among Veterans, United States, 2005\u20132014.","volume":"14","author":"Y Liu","year":"2017","journal-title":"Prev Chronic Dis."},{"key":"pone.0301260.ref002","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic Foot Ulcers and Their Recurrence.","volume":"376","author":"DG Armstrong","year":"2017","journal-title":"New England Journal of Medicine"},{"key":"pone.0301260.ref003","article-title":"Association between race\/ethnicity and the risk of amputation of lower extremities among medicare beneficiaries with diabetic foot ulcers and diabetic foot infections","volume":"8","author":"TW Tan","year":"2020","journal-title":"BMJ Open Diabetes Res Care"},{"key":"pone.0301260.ref004","article-title":"Incidence of diabetic foot ulcer and lower extremity amputation among Medicare beneficiaries, 2006 to 2008: Data Points #2.","author":"DJ Margolis","year":"2011","journal-title":"Data Points Publication Series."},{"key":"pone.0301260.ref005","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1161\/ATVBAHA.120.314595","article-title":"Epidemiology and risk of amputation in patients with diabetes mellitus and peripheral artery disease","volume":"40","author":"JA Barnes","year":"2020","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"pone.0301260.ref006","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/j.jvs.2019.10.090","article-title":"The effect of rurality on the risk of primary amputation is amplified by race","volume":"72","author":"SD Minc","year":"2020","journal-title":"J Vasc Surg"},{"key":"pone.0301260.ref007","first-page":"560","article-title":"Racial\/ethnic Disparities in Lower Extremity Amputation Vs Revascularization: A Brief Review.","volume-title":"Journal of the National Medical Association","author":"K Hughes","year":"2018"},{"key":"pone.0301260.ref008","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(17)30569-X","article-title":"Structural racism and health inequities in the USA: evidence and interventions","volume":"389","author":"ZD Bailey","year":"2017","journal-title":"The Lancet"},{"key":"pone.0301260.ref009","doi-asserted-by":"crossref","first-page":"2642","DOI":"10.2337\/diacare.27.11.2642","article-title":"Home monitoring of foot skin temperatures to prevent ulceration","volume":"27","author":"LA Lavery","year":"2004","journal-title":"Diabetes Care"},{"key":"pone.0301260.ref010","doi-asserted-by":"crossref","first-page":"14","DOI":"10.2337\/dc06-1600","article-title":"Preventing diabetic foot ulcer recurrence in high-risk patients: Use of temperature monitoring as a self-assessment tool","volume":"30","author":"LA Lavery","year":"2007","journal-title":"Diabetes Care"},{"key":"pone.0301260.ref011","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/j.amjmed.2007.06.028","article-title":"Skin Temperature Monitoring Reduces the Risk for Diabetic Foot Ulceration in High-risk Patients.","volume":"120","author":"DG Armstrong","year":"2007","journal-title":"American Journal of Medicine"},{"key":"pone.0301260.ref012","doi-asserted-by":"crossref","DOI":"10.1186\/s12902-015-0054-x","article-title":"A pilot study testing the feasibility of skin temperature monitoring to reduce recurrent foot ulcers in patients with diabetes\u2014a randomized controlled trial.","volume":"15","author":"A Skafjeld","year":"2015","journal-title":"BMC Endocr Disord."},{"key":"pone.0301260.ref013","article-title":"Effectiveness of at-home skin temperature monitoring in reducing the incidence of foot ulcer recurrence in people with diabetes: A multicenter randomized controlled trial (DIATEMP).","volume":"9","author":"SA Bus","year":"2021","journal-title":"BMJ Open Diabetes Res Care."},{"key":"pone.0301260.ref014","article-title":"Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update).","volume":"36","author":"SA Bus","year":"2020","journal-title":"Diabetes Metab Res Rev."},{"key":"pone.0301260.ref015","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1016\/j.jvs.2015.10.003","article-title":"The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine","volume":"63","author":"A Hingorani","year":"2016","journal-title":"J Vasc Surg"},{"key":"pone.0301260.ref016","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1111\/wrr.12391","article-title":"WHS guidelines update: Diabetic foot ulcer treatment guidelines.","volume":"24","author":"LA Lavery","year":"2016","journal-title":"Wound Repair Regen"},{"key":"pone.0301260.ref017","first-page":"114","article-title":"Remote Temperature Monitoring of the Diabetic Foot: From Research to Practice.","volume":"37","author":"GM Rothenberg","year":"2020","journal-title":"Fed Pract."},{"key":"pone.0301260.ref018","doi-asserted-by":"crossref","DOI":"10.1002\/dmrr.3239","article-title":"Leveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer-free days in remission","volume":"36","author":"B Najafi","year":"2020","journal-title":"Diabetes Metab Res Rev"},{"key":"pone.0301260.ref019","doi-asserted-by":"crossref","first-page":"973","DOI":"10.2337\/dc16-2294","article-title":"Feasibility and efficacy of a smart mat technology to predict development of diabetic plantar ulcers","author":"RG Frykberg","year":"2017","journal-title":"Diabetes Care"},{"key":"pone.0301260.ref020","doi-asserted-by":"crossref","DOI":"10.1016\/j.diabres.2020.108074","article-title":"Accuracy of a foot temperature monitoring mat for predicting diabetic foot ulcers in patients with recent wounds or partial foot amputation","volume":"161","author":"IL Gordon","year":"2020","journal-title":"Diabetes Res Clin Pract"},{"journal-title":"VHA Benefits & Health Care Utilization.","author":"Department of Veterans Affairs","key":"pone.0301260.ref021"},{"journal-title":"VHA Support Services Center (VSSC).","key":"pone.0301260.ref022"},{"journal-title":"VHA Innovators Network.","author":"Department of Veterans Affairs","key":"pone.0301260.ref023"},{"journal-title":"How Innovation and Partnership are Ending Diabetic Limb Loss at VA\u2014VAntage Point","author":"M. Razak","key":"pone.0301260.ref024"},{"key":"pone.0301260.ref025","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.2337\/dc22-1492","article-title":"Evaluation of the Effectiveness of Remote Foot Temperature Monitoring for Prevention of Amputation in a Large Integrated Health Care System","volume":"46","author":"AJ Littman","year":"2023","journal-title":"Diabetes Care"},{"key":"pone.0301260.ref026","doi-asserted-by":"crossref","DOI":"10.1002\/dmrr.3621","article-title":"Does the skin heat up before it breaks down in diabetic foot ulceration?","volume":"39","author":"WB aan de Stegge","year":"2023","journal-title":"Diabetes Metab Res Rev"},{"journal-title":"In: ClinicalTrials.gov NCT05728411 [Internet].","key":"pone.0301260.ref027","article-title":"Effectiveness of Remote Foot Temperature Monitoring (STOP)."},{"key":"pone.0301260.ref028","doi-asserted-by":"crossref","DOI":"10.5888\/pcd15.170271","article-title":"Pragmatic applications of RE-AIM for health care initiatives in community and clinical settings.","volume":"15","author":"RE Glasgow","year":"2018","journal-title":"Prev Chronic Dis."},{"key":"pone.0301260.ref029","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1111\/j.1475-6773.2010.01107.x","article-title":"Relationship between Clinical Conditions and Use of Veterans Affairs Health Care among Medicare-Enrolled Veterans.","volume":"45","author":"LA Petersen","year":"2010","journal-title":"Health Serv Res"},{"key":"pone.0301260.ref030","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/j.1748-0361.2010.00298.x","article-title":"Defining \u201cRural\u201d for Veterans\u2019 health care planning.","volume":"26","author":"AN West","year":"2010","journal-title":"Journal of Rural Health"},{"key":"pone.0301260.ref031","doi-asserted-by":"crossref","first-page":"2456","DOI":"10.1056\/NEJMp1802313","article-title":"Making Neighborhood-Disadvantage Metrics Accessible\u2014The Neighborhood Atlas.","volume":"378","author":"AJH Kind","year":"2018","journal-title":"New England Journal of Medicine"},{"key":"pone.0301260.ref032","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.jclinepi.2010.10.004","article-title":"A combined comorbidity score predicted mortality in elderly patients better than existing scores.","volume":"64","author":"JJ Gagne","year":"2011","journal-title":"J Clin Epidemiol"},{"journal-title":"VA\/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF TYPE 2 DIABETES MELLITUS IN PRIMARY CARE VA\/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus in Primary Care The Management of Type 2 Diabetes Mellitus in Primary Care","year":"2017","key":"pone.0301260.ref033"},{"key":"pone.0301260.ref034","first-page":"1","article-title":"mice: Multivariate imputation by chained equations in R.","volume":"45","author":"S van Buuren","year":"2011","journal-title":"J Stat Softw"},{"volume-title":"Multiple Imputation for Nonresponse in Surveys","year":"2004","author":"D. Rubin","key":"pone.0301260.ref035"},{"key":"pone.0301260.ref036","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1093\/biomet\/86.4.948","article-title":"Small-sample degrees of freedom with multiple imputation","volume":"86","author":"J Barnard","year":"1999","journal-title":"Biometrika"},{"key":"pone.0301260.ref037","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1080\/01621459.1992.10475190","article-title":"Generalized collinearity diagnostics","volume":"87","author":"J Fox","year":"1992","journal-title":"J Am Stat Assoc"},{"key":"pone.0301260.ref038","first-page":"361","article-title":"Multivariable prognostic models: Issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors","author":"FE Harrell","year":"1996","journal-title":"In: Statistics in Medicine [Internet]."},{"key":"pone.0301260.ref039","first-page":"1","article-title":"Expanding Access through Virtual Care: The VA\u2019s Early Experience with Covid-19","volume":"1","author":"L Heyworth","year":"2020","journal-title":"New England Journal of Medicine Catal Innov Deliv"},{"key":"pone.0301260.ref040","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1007\/s11606-021-07301-7","article-title":"Type 2 Diabetes Management, Control and Outcomes During the COVID-19 Pandemic in Older US Veterans: an Observational Study","volume":"37","author":"CE Aubert","year":"2022","journal-title":"J Gen Intern Med"},{"journal-title":"COVID-19 and diabetic foot disease","author":"IWGDF","key":"pone.0301260.ref041"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301260","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T17:40:38Z","timestamp":1711993238000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301260"}},"subtitle":[],"editor":[{"given":"Yoshihisa","family":"Tsuji","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,4,1]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0301260","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2024,4,1]]}}}