SAN FRANCISCO — To improve the level of foot care that family medicine residents provided to diabetic patients, their teachers at the Medical College of Wisconsin put a sock in it.
Literally.
“We came up with this idea that to bring [diabetic] foot care to a level we wanted it to be, we should award a pair of socks to every physician who helped us get there,” said Robin Helm, M.D, associate director of the St. Michael Hospital Family Practice Residency Program in Milwaukee.
The effort was designed to raise compliance with the foot-exam benchmark of the Diabetes Physician Recognition Program, a national quality-of-care project of the American Diabetes Association and the National Committee for Quality Assurance.
For compliance checking, electronic medical records were analyzed for all 18 residents and 6 faculty members who treated or examined diabetes patients. What impact did the socks have? Compliance soared to 85%.
Dr. Helm outlined what was jokingly referred to as “the sock-it-to-–em program” at the annual meeting of the Society of Teachers of Family Medicine. She and Beth Damitz, M.D., the medical director of the program's family care center, gave an informal talk, along with Sandra Olsen, the program administrator. All three were stunned to see the rates of compliance zoom, once the socks were dangled as an incentive.
“I tried to get bright, fun sort of socks. But they were from just a regular store, maybe a little flashier, but nothing special,” Dr. Helm said. In fact, some male residents thought the socks were “too feminine,” so the trio found keychains with charms of tiny feet. “This was given instead of socks to them, but it had the same effect.
“At first it seemed kind of goofy,” Ms. Olsen said. However, at the monthly meetings of faculty and residents, a “big deal” was made when the socks were ceremoniously handed out. “After a while, we had residents who said 'I know I should qualify, and I haven't gotten my socks yet!'” observed Dr. Helm.
The physician recognition program's benchmark for diabetic foot exams is 75% compliance, and the “rates started out dismally, at about 5%,” Ms. Olsen said at the meeting sponsored by the American Academy of Family Physicians. Now, with 600 diabetic patients being seen intermittently, the rate is inching to 90%.
Another reason for the now-high compliance may be that letters are sent out to all patients, reminding them to bare their feet during visits. Dr. Helm said she did not know why the initial foot exams were so rarely undertaken. She speculated that some residents may have thought it invasive to have a patient remove shoes and socks after they reported no problems with their feet.