# Reducing major amputations for rural patients with diabetic foot ulcers: the who’s and how’s of integrated care.

> **NIH AHRQ K08** · UNIVERSITY OF WISCONSIN-MADISON · 2020 · $158,220

## Abstract

PROJECT SUMMARY ABSTRACT
Nearly 2 million Americans develop a diabetic foot ulcer each year. Dr. Brennan's research team and others
documented a >50% mortality and 5% major amputation rate within 5-years of ulceration. Next, they
determined that morbidity and mortality associated with ulcers disproportionately burdens rural patients, who
have 50% higher odds of major amputation and 40% higher odds of death than urban patients. Dr. Brennan's
long-term objective is to eliminate this rural disparity through interventions that improve the quality of diabetic
foot ulcer care rural patients receive in the ambulatory setting.
Over the past decade, many urban tertiary care centers have developed a model of integrated care for patients
with diabetic foot ulcers. The integrated care model involves multiple specialists working side-by-side and
following a care algorithm to address 4 precipitating physiologic factors in a coordinated manner: poor glycemic
control, vascular disease, mechanical complications, and secondary infection. Dr. Brennan's systematic review
found that 97% of these urban integrated care clinics reduced major amputation, with relative risk reductions
ranging from 11 to 90%. However, this urban model is difficult to implement in the rural setting, where
providers are scarce and geographically dispersed.
Dr. Brennan's goal is to become an academic clinician-researcher in infectious disease leading an independent
research program to improve care and outcomes of diabetic foot ulcers in rural settings. She proposes a 3-year
K08 period with training in clinical trials, stakeholder engagement, systems engineering, implementation
science, and advanced quantitative skills. Following her KL2 support, Dr. Brennan is well prepared for a
successful K08 award period. Her focused training, expert mentorship, and research plan will catalyze her
transition to independence. This proposal heralds her advancement from defining gaps in care to closing them.
The primary objective of this proposal is to build and pilot an integrated care algorithm adapted to the rural
setting. The proposed aims are to: 1) identify which specialists are associated with increased amputation-free
survival, and the optimal timing of their involvement 2) co-design an integrated care algorithm and its
implementation plan with rural healthcare systems, and 3) pilot the algorithm in the rural setting to maximize
adoption and implementation. Upon completion of the proposed research and training, Dr. Brennan will be
ideally poised to submit a competitive AHRQ R01 centered on testing the emerging intervention with an
effectiveness-implementation study. Her current and future research aims will advance AHRQ's mission by
focusing on a high-priority population (rural patients), problem (major amputation), and area of interest
(ambulatory care).

## Key facts

- **NIH application ID:** 9962414
- **Project number:** 5K08HS026279-02
- **Recipient organization:** UNIVERSITY OF WISCONSIN-MADISON
- **Principal Investigator:** Meghan Brennan
- **Activity code:** K08 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $158,220
- **Award type:** 5
- **Project period:** 2019-07-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9962414

## Citation

> US National Institutes of Health, RePORTER application 9962414, Reducing major amputations for rural patients with diabetic foot ulcers: the who’s and how’s of integrated care. (5K08HS026279-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9962414. Licensed CC0.

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