Association between Annual Wellness Visits and Major Amputations among Medicare Beneficiaries in the Diabetes Belt

Objective: Annual Wellness Visits (AWVs) are yearly visits for Medicare beneficiaries that include discussing preventive care needs and scheduling future preventive care services. Our prior work found that AWVs are associated with increased utilization of preventive care for diabetes patients, including uptake of foot exams. Our objective is to determine whether AWVs are associated with a reduced risk of major lower-extremity amputations (MLEAs) for patients in the Diabetes Belt. Methods: Our analysis used a sample of approximately 900,000 Medicare Fee-for-Service beneficiaries from 2015 that lived in the Diabetes Belt and surrounding areas. The Diabetes Belt is a region of 644 counties in the Appalachian and deep south areas of the US identified by the CDC in 20 that continues to have a high prevalence. We used multivariable logistic regression to examine the association between AWVs and MLEAs in 2015, adjusting for demographic factors, comorbidities, major risk factors including diabetic foot ulcers, neuropathy, peripheral vascular disease, and access to care factors. Results: The rate of MLEAs was significantly lower among patients in the Diabetes Belt who had an AWV in the last year. The odds of MLEAs were 36% lower in patients who used AWVs in the same year compared to those who did not, adjusting for all covariates. We also found that patients in the Diabetes Belt had about 27% higher odds of having an MLEA compared to those residing in the surrounding areas. Discussion: Patients who used AWVs may have had their diabetic foot examined sooner to prevent a major adverse outcome than those who did not. Policy makers should prioritize incentives for having patients participate in AWVs to help reduce MLEAs. Disclosure J.M.Lobo: n/a. S.Kim: None. H.Kang: None. M.Sohn: None. Funding NIH/NIDDK R01DK113295