[AVBC 2025] Diabetic Foot in Primary and Tertiary (DEFINITE) Care: A Population-Based Diabetic Foot Ulcer Prog
Care Process & Redesign
Appropriate & Value-based Care Conference
National Healthcare Group
5 December 2025
To implement and evaluate an integrated, value-based care model for diabetic foot ulcer (DFU) management across the care. DEFINITE Care demonstrates that integrated DFU care significantly improves clinical, experiential, and economic outcomes.
Year Submitted: 2025
Published Date: 05 December 2025
Tags: Care Process ＆ Redesign, Value Based Care, Safe Care, Risk Management, Preventive Approach, Adverse Outcome Reduction, Workflow Redesign, Quality Improvement, Functional Outcome
About this Content
Aims
To implement and evaluate an integrated, value-based care model for diabetic foot ulcer (DFU) management across the care continuum, with the goal of improving outcomes and reducing lower extremity amputation (LEA) rates.
Background
DFUs are high-burden complications of diabetes associated with significant morbidity and cost. Prior to 2020, care within the cluster was fragmented, contributing to poor outcomes. DEFINITE (Diabetic Foot in Primary and Tertiary) Care was launched to close these gaps through a population-based, end-to-end service transformation.
Methods
A multidisciplinary pathway was rolled out across the National Healthcare Group, comprising: Risk-stratified screening at primary care, Early referrals for DFU cases, Dedicated multidisciplinary limb salvage clinics (LEAPP), PROMs via DFS-SF and PREMs using the Outpatient Experience Questionnaire (OPEQ). Outcomes from June 2020 to July 2024 were compared to a propensity-matched 20162017 historical cohort. Health economic analyses included cost-effectiveness and mortality benefit.
Results
Among 7,215 patients enrolled, 12-month minor and major amputation-free survival improved by 4.9% and 9.0%, respectively. Each patient had 0.98 fewer admissions, with inpatient stay reduced by 5.5 days. The programme prevented an estimated 270 deaths annually, at S$24,498 per death prevented. ICER was S$30,564 per QALY gained. NHG's major amputation rate was 8.0/100,000, lower than the national average of 12.1. Over 48 months, major LEA declined from 5.9% to 0.4%; minor LEA from 12.4% to 1.0%. PROMs showed improved foot carerelated QoL in pain, physical activity, and dependence domains. PREMs revealed positive experiences in clinic organisation, facilities, and consultations (mean scores 7.49.2), though patients reported difficulty reaching clinic staff.
Conclusion
DEFINITE Care demonstrates that integrated DFU care significantly improves clinical, experiential, and economic outcomes. Its scalable, value-based model has potential for broader adoption to reduce diabetes-related complications and enhance patient-centred care.
Lessons Learnt
Challenges in reaching clinic staff were reported by patients, indicating a need for improved communication channels.
Keywords
Diabetic Foot, Amputation, Care Model, Outcomes, Value-Based
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Woodlands Health |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | Endocrinology |
Project Lead(s) | Zhiwen Joseph LO |
Project Member(s) | Zhiwen Joseph LO |
Connect with this contributor!
Zhiwen Joseph LO - zhiwen.lo@nhghealth.com.sg