FOOT EXAMS

A new coverage decision by the Centers for Medicare and Medicaid Services (CMS) includes foot exams for Medicare beneficiaries with diabetes and peripheral neuropathy. The new guideline will allow Medicare beneficiaries with diabetes and peripheral neuropathy with loss of protective sensation due to diabetes to receive foot care exams every 6 months.

Interestingly, a survey conducted by the American Podiatric Medical Association (APMA) at about the same time as the CMS coverage decision was announced found that 87% of respondents had never had their feet examined as part of a routine physical examination. Another 8% said their physicians sometimes examined their feet, and 6% said their physicians always examined their feet. The survey was posted at the APMA Web site, http://www.apma.org, on September 21, 2001; as of November 14, 820 people had participated in the poll.

PATIENT SAFETY

The use of pressure-relieving bedding to prevent pressure ulcers ranks as one of the top 11 safety practices identified by the Agency for Healthcare Research and Quality (AHRQ) in its report, "Making Health Care Safer. A Critical Analysis of Patient Safety Practices." The report ranks 73 risk-reduction measures to improve patient safety that are backed by comprehensive evidence-based reviews; it also presents a number of promising items that need further research.

Patient safety has become a major concern since the 1999 publication of the institute of Medicine's To Err is Human: Building a Safer Health System. AHRQ's report states that improving patient safety often involves the coordinated effort of multiple members of the health care team, who may adopt strategies from outside health care. The AHRQ designed the report as the first step toward what director John Eisenberg, MD, calls "evidence-based management."

PRESSURE ULCERS

The National Pressure Ulcer Advisory Panel (NPUAP), Reston, VA, has established a task force to review the issue of purple pressure ulcers. These lesions are often described as Stage I pressure ulcers under current NPUAP definitions but may involve deep tissue damage that can rapidly progress to deep Stage II to IV pressure ulcers. The specific aims of the task force are to determine the state of knowledge with respect to understanding the epidemiology, natural history, evaluation, and treatment of pressure-related tissue damage under intact skin; identify potential methods that might be utilized to improve the diagnosis of minor versus more extensive tissue damage under intact skin; and recommend opportunities for future research regarding these lesions.