# Evaluating Implementation of Comprehensive Assessment and Telemedicine Consultation to Prevent Amputations for Patients with Lower Extremity Ulcers in Rural Health Clinics.

> **NIH NIH K23** · UNIVERSITY OF CALIFORNIA AT DAVIS · 2020 · $157,408

## Abstract

Project Summary/ Abstract
 $25 billion is spent annually to care for patients with lower extremity ulcers due to peripheral artery
disease (PAD) and Diabetes Mellitus (DM) in the United States. Despite this over 185,000 patients with PAD,
DM, or combined PAD/DM undergo leg amputation with a risk of 55% for amputation of the opposite leg. In rural
patients the risk is 50% higher compared to urban areas. Guidelines for treating lower extremity ulcers are
founded on objective evaluation of arterial perfusion with ankle brachial index (ABI) testing and characterization
of the ulcer using a validated classification system (WIfI). Barriers to implementation of both include poor
dissemination among primary providers, questions of how to implement tools within a busy clinical practice, and
limited access to subsequent treatment. Adoption of telemedicine to manage patients with lower extremity
ulcers has been low; however, we believe that the use of telemedicine in addition to dissemination and
implementation of evidence based guidelines can improve timing of care and may reduce hospitalizations,
emergency room visits, and amputations.
 My long-term goal is to decrease preventable amputations for patients with foot ulcers due to DM and/or
PAD. My immediate goal is to develop my skills as an implementation science researcher with a focus on
bringing evidence based guidelines to rural clinics and providing specialty care using telemedicine, and
evaluating the effect of patient activation influences outcomes. The K23 award will support my time to
implement ABI and WIfI use in rural clinics and to use telemedicine to improve timing of care, which may
ultimately decrease hospitalizations and amputations.
 There are several relevant and complementary resources available to me within the environment at UC
Davis. First and foremost, the NIH Clinical & Translational Science Center (CTSC) represents a substantial
resource pool including grant and statistical support as well as Informatics and database support. The UC Davis
Center for Healthcare and Technology (CHT), where Dr. Marcin serves as the Director of Pediatric
Telemedicine, has all the resources needed to conduct specialist consultation through telemedicine already in
place. Finally, the UC Davis Center for Healthcare Policy and Research (CHPR), led by Joy Melnikow, has a
robust network of qualitative researchers with experience in patient centered studies as well as health policy
researchers to provide methods expertise and support implementation of the project. The UC Davis Surgical
Outcomes Group, of which I am a member, holds monthly meetings to discuss “research in progress”. This
group will serve as a valuable tool for reviewing ideas and analytical work during my grant. Overall, without the
collaborative nature at UC Davis, I would not be able to succeed in this proposal.

## Key facts

- **NIH application ID:** 9891085
- **Project number:** 5K23HL143178-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA AT DAVIS
- **Principal Investigator:** Misty Dawn Humphries
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $157,408
- **Award type:** 5
- **Project period:** 2019-04-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9891085

## Citation

> US National Institutes of Health, RePORTER application 9891085, Evaluating Implementation of Comprehensive Assessment and Telemedicine Consultation to Prevent Amputations for Patients with Lower Extremity Ulcers in Rural Health Clinics. (5K23HL143178-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9891085. Licensed CC0.

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