The Effect of Structured Out-of-Hospital Continuity of Care on Wound Healing and Quality of Life in Severe Diabetic Foot Ulcer: A Retrospective Comparative Study

Background To assess the impact of a structured out-of-hospital continuity of care intervention on diabetic ulcer healing and patient-reported outcomes in individuals with severe diabetic foot ulcers (DFUs; Wagner grades 4–5), and to identify prognostic factors influencing healing. Methods This retrospective comparative study included 91 inpatients with severe DFUs. 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-discharged follow-up. Evaluations included ulcer healing status, time to complete wound closure, and health-related quality of life (HRQoL). Factors related to wound healing were assessed using Cox proportional hazards regression. Results 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%), a clinically relevant difference that did not reach statistical significant ( P  = 0.060). A transient improvement in HRQoL (EQ-5D-5L) was observed in the intervention group at the 6-month assessment ( P  = 0.029), whereas no significant between-group differences in pain intensity (VAS) were found at any point. Multivariable Cox regression analysis identified Wagner grade 5 (adjusted Hazard Ratio [HR] = 0.15, P<0.001 ) and peripheral artery disease (adjusted HR = 0.58, P = 0.036 ) as significant independent predictors of delayed healing. Conclusion For patients with severe DFUs, the implementation of a structured out-of-hospital continuity of care model did not significantly shorten healing time but was associated with a clinically relevant increase in healing rates and short-term quality of life benefits. Ulcer severity and peripheral artery disease were confirmed as critical prognostic factors. Larger studies are warranted to confirm these findings.