Global Wound Outcomes

  Applying recognized outcomes management principles can transform the process of caring for wounds into getting results that matter for patients, providers, practice settings, or nations struggling to meet increasing wound care challenges. Documenting and reviewing outcomes in the context of best available evidence frees wound care professionals to replace protocols that aren’t working with those that propel progress toward wound and patient goals.   Previous WOUNDS issues focused on wound outcomes, defined outcomes research and explored its implementation around the world. In the following pages, authors explore how to document and implement wound outcomes in practice: listing choices of wound outcomes to measure, describing how outcome databases add value to one’s practice, and comparing wound outcomes in one’s practice to relevant published benchmarks.   The wound outcomes one chooses to measure should be reliable, valid, and relevant to the needs and goals of patients and wounds served, as well as provider and institutional priorities. Professor Gottrup and colleagues summarize measured wound outcome options supported by various evidence. The variety of choices may seem formidable, but it is likely that the highest priority outcomes are already being measured and documented in one’s setting. To optimize wound and patient benefits share these outcomes with the wound care team to help guide care decisions. The more quickly wound care providers learn about the results of their care the faster they will learn of the need for improvements in the care plan. If a care plan is working, outcomes reveal progress toward the goals of care. If not, poor outcomes alert one to address poor progress before catastrophe adds to the burden of wound care.   Dr. Fife and colleagues describe a wound registry to store, analyze, and communicate wound outcomes results. Outcomes from a wound registry can provide vital feedback on progress toward meeting wound and patient goals. Alternatively, they can serve to focus resources on high-risk patients to avoid tissue injury or on high-risk wounds to assure that they stay on the path to healing. Outcomes measured, documented, and reported in one’s institution can support reimbursement and highlight quality care or areas of care that need to improve. They can tell the world about the results you are achieving to meet your patient and wound needs and goals. Dr. Fife and her group analyze wound care outcomes and costs in a Wound Registry outcomes database, identifying important cost drivers and differences in the costs of interventions. Analyzing such outcomes in one’s practice can support decisions that improve the economic value of wound care interventions for patients, providers, and payers.   Wound care teams can also use wound or patient outcomes data to identify and focus resources on wound and patient risk factors for tissue breakdown or for nonhealing. For example, large area, deeper depth, or long duration wounds, or patients with diabetes, peripheral vascular disease, or obesity are likely to heal more slowly without special attention. Alerting staff to address these risk factors early can head off wound or skin deterioration and direct care toward patients and wounds with the greatest need. Documenting risk factors becomes a powerful force for improving wound outcomes only if individual patient and wound risk factors are recognized by appropriate staff and addressed.   In a competitive healthcare environment, it can be important to know how the care delivered by one’s practice “measures up” to that delivered elsewhere—this is referred to as “benchmarking.” The third wound outcomes article in this issue of WOUNDS describes benchmarking techniques to evaluate the relative merit of wound outcomes from one’s practice or for an individual patient. Evidence-based resources useful in benchmarking are described and used to illustrate benchmarking of results from a single practice compared to those reported in some large randomized controlled trials (RCT). With careful attention to selecting relevant benchmarks, a wound care provider can evaluate the relative merit of care currently delivered to his or her patients, compared to that derived by a precisely controlled protocol applied in a RCT or less precisely controlled protocol applied in a wound registry. Armed with this information wound care providers can inform decisions to improve or maintain current wound care protocols. References 1. Wojner A. Outcomes Management: Applications to Clinical Practice. St. Louis, MO: Mosby; 2001. 2. Bolton L. Section Editor’s Message: Outcomes Research. WOUNDS. 2004;16(5):148–149. 3. Bolton L. Section Editor’s Message: Outcomes Research. WOUNDS. 2007;19(11):285. 4. Kurd SK, Hoffstad OJ, Bilker WB, Margolis DJ. Evaluation of the use of prognostic information for the care of individuals with venous leg ulcers or diabetic neuropathic foot ulcers. Wound Repair Regen. 2009;17(3):318–325. Dr. Bolton is an Adjunct Associate Professor, Department of Surgery, UMDNJ and WOUNDS Editorial Advisory Board Member. Address correspondence to: Laura Bolton, PhD, FAPWCA 15 Franklyn Place Metuchen, NJ 08840 llbolton@gmail.com