Table 12.1.

The three tiers of care for amputation prevention and diabetic foot care centers

Clinical level of care	Setting	Potential clinicians	Role
Basic model of care	General practitioner’s office, health center, small community hospital	General practitioner Internist Endocrinologist Podiatrist Diabetic nurse Physical therapist	Close collaboration with a referral center
Intermediate model of care	Regional hospital or multidisciplinary clinic	Endocrinologist Vascular surgeon Interventionalist Orthopedic surgeon Podiatric surgeon Diabetic nurse Wound nurse Physical therapist Diabetes educator Nutritionist	Active collaboration with other departments in the hospital and extramural facilities
Center of Excellence	Large teaching hospital, tertiary referral center	Endocrinologist Vascular surgeon Interventionalist Podiatric surgeon Orthopedic surgeon Infectious disease specialist Orthotist Diabetes educator Nutritionist Wound nurse Physical therapist	Collects and reports outcomes; facilitates regional education

Adapted from Rogers LC, Andros G, Caporusso J, Harkless LB, Mills JL Sr, Armstrong DG. Toe and flow. J Am Podiatr Med Assoc 2010;100:342–8.