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Diabetic foot is one of the most complex and costly complications of diabetes mellitus, associated with high morbidity, risk of amputation, and a substantial impact on quality of life. Traditional care models, often fragmented and volume-driven, are insufficient to ensure optimal outcomes and long-term sustainability. In this context, Value-Based Health Care (VBHC) has emerged as a strategic approach aimed at maximizing clinical outcomes and patient-relevant outcomes relative to the resources used.

Within the Local Health Authority South East Tuscany, a structured initiative was undertaken to apply the VBHC framework to diabetes and diabetic foot care pathways. This process involved the establishment of a multiprofessional working group (33 people), led by industrial engineers, including clinicians, administrative personnel, and executive management staff, with the goal of redesigning care delivery according to value-based principles.

Key actions included the analysis and standardization of clinical pathways, the identification of relevant outcome indicators (including patient-reported outcome measures), and the evaluation of resource utilization across the full cycle of care. Particular attention was given to early risk stratification, timely access to specialized care, and the integration between hospital and community services.

This organizational approach aims to improve clinical outcomes, reduce variability in care, and enhance resource allocation efficiency. Preliminary observations suggest that the adoption of a VBHC-oriented model may support a more coordinated, patient-centered management of diabetic foot, while fostering greater alignment between clinical and managerial perspectives.

The experience highlights both the potential benefits and the operational challenges of implementing VBHC in a real-world setting, emphasizing the need for cultural change, data integration, and sustained institutional commitment.