Association of structured out-of-hospital continuity of care with wound healing and quality of life in severe diabetic foot ulcer: a retrospective exploratory study

To evaluate the association of a structured out-of-hospital continuity of care intervention with diabetic ulcer healing and patient-reported outcomes in individuals with severe diabetic foot ulcers (DFUs), and to identify prognostic factors influencing healing. This retrospective comparative study included 91 inpatients with severe DFUs (Wagner grades 4–5). The intervention group ( n = 45) received a structured out-of-hospital care protocol comprising domiciliary visits, remote monitoring, and access to specialized care as needed. The control group ( n = 46) was provided with standard post-discharge follow-up. Outcomes included ulcer healing status, time to complete wound closure, and health-related quality of life (HRQoL). Factors related to wound healing were assessed using Fine-Gray competing risks regression, with major amputation and death treated as competing events. Over a mean follow-up of 10.74 ± 9.05 months, the intervention group showed a higher ulcer healing rate compared to the control group (82.22% vs. 63.04%; difference 19.20%, 95% CI: 0.80% − 37.50%, p = 0.060). In the Fine-Gray competing risks analysis, the intervention group was associated with a significantly higher probability of healing (subdistribution hazard ratio = 1.74, 95% CI: 1.08–2.83, p = 0.024). Regarding HRQoL, a transient between-group difference in EQ-5D-5L was observed at 6 months ( p = 0.029), but the group-by-time interaction was not significant ( p = 0.220), indicating no sustained improvement. In this exploratory retrospective study, structured out-of-hospital continuity of care was associated with a statistically non-significant increase in crude healing rates. After accounting for competing risks, a significant association was observed in the primary analysis. However, this effect was attenuated and no longer significant in additional baseline severity factors (ABI and ulcer location). A transient improvement in quality of life at 6 months was not sustained. Ulcer severity and peripheral artery disease were identified as independent prognostic factors. Larger prospective studies are needed to confirm these exploratory findings.