Development of a generic wound care assessment minimum data set

Coleman, Susanne; Nelson, E Andrea; Vowden, Peter; Vowden, Kathryn; Adderley, Una; Sunderland, L.; Harker, Judy; Conroy, Tracy; Fiori, Sarah; Bezer, Nicola; Holding, Emma; Atkin, Leanne; Stables, Emma; Dumville, Jo C; Gavelle, Sue; Sandoz, Heidi; Moore, Keith; Chambers, T L; Napper, Sally; Nixon, Jane

doi:10.1016/j.jtv.2017.09.007

Cited by 43 publications

(42 citation statements)

References 27 publications

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“…A wound assessment minimum data set has been developed within NHS England to support clinical practice, documentation and reported quality standards (Commissioning for Quality and Innovation (CQUIN)). 27 Despite these limitations, it is the authors’ opinion that the real-world evidence contained in the THIN database has provided a useful perspective on the management of PUs in the community in the UK and the associated costs.…”

Section: Discussionmentioning

confidence: 99%

Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes

et al. 2018

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ObjectivesThe aim of this study was to estimate the patterns of care and annual levels of healthcare resource use attributable to managing pressure ulcers (PUs) in clinical practice in the community by the UK’s National Health Service (NHS), and the associated costs of patient management.MethodsThis was a retrospective cohort analysis of the records of 209 patients identified within a randomly selected population of 6000 patients with any type of wound obtained from The Health Improvement Network (THIN) Database, who developed a PU in the community and excluded hospital-acquired PUs. Patients’ characteristics, wound-related health outcomes and healthcare resource use were quantified over 12 months from initial presentation, and the corresponding total NHS cost of patient management was estimated at 2015/2016 prices.Results50% of all the PUs healed within 12 months from initial presentation, but this varied between 100% for category 1 ulcers and 21% for category 4 ulcers. The mean time to healing ranged from 1.0 month for a category 1 ulcer to 8 months for a category 3/4 ulcer and 10 months for an unstageable ulcer. Patients were predominantly managed in the community by nurses with minimal clinical involvement of specialist clinicians. Up to 53% of all the ulcers may have been clinically infected at the time of presentation, and 35% of patients subsequently developed a putative wound infection a mean 4.7 months after initial presentation. The mean NHS cost of wound care over 12 months ranged from £1400 for a category 1 ulcer to >£8500 for the other categories of ulcer. Additionally, the cost of managing an unhealed ulcer was 2.4 times more than that of managing a healed ulcer (mean of £5140 vs £12 300 per ulcer).ConclusionThis study provides important insights into a number of aspects of PU management in clinical practice in the community that have been difficult to ascertain from other studies, and provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions.

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Section: Discussionmentioning

confidence: 99%

Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes

et al. 2018

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“…9 However, the uptake of these innovations and use of evidence-based treatment practices remain limited. 1,2,10 For other chronic conditions, payment reform has been proposed as a policy intervention to improve quality of care because the established fee-for-service payment system is increasingly regarded as failing to reward high-quality care. 4 The Centers for Medicare and Medicaid Services has charted an ambitious course to reorient its payment models to value and has introduced such models for several chronic conditions.…”

Section: Introductionmentioning

confidence: 99%

“…Chronic wounds, usually defined as wounds that do not heal within an expected time frame, typically 4–12 weeks, are a growing but little recognized public health challenge. 1 , 2 Their prevalence is similar to that of heart failure, affecting 6.5 million people or 2% of the population in the United States. 3 In 2014, estimated Medicare expenditure related to managing chronic wounds and associated complications ranged between $28.1 and $96.8 billion.…”

Section: Introductionmentioning

confidence: 99%

Development of a Model to Predict Healing of Chronic Wounds Within 12 Weeks

Cho

Mattke

Gordon³

et al. 2020

Advances in Wound Care

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Pré cis: Using both clinically informed and machine learning approaches, we developed a prediction model for chronic wound healing that can form the basis for quality measurement. Objective: Chronic wounds represent a highly prevalent but little recognized condition with substantial implications for patients and payers. While better wound care products and treatment modalities are known to improve healing rates, they are inconsistently used in real-world practice. Predicting healing rates of chronic wounds and comparing to actual rates could be used to detect and reward better quality of care. We developed a prediction model for chronic wound healing. Approach: We analyzed electronic medical records (EMRs) for 620,356 chronic wounds of various etiologies in 261,398 patients from 532 wound care clinics in the United States. Patient-level and wound-level parameters influencing wound healing were identified from prior research and clinician input. Logistic regression and classification tree models to predict the probability of wound healing within 12 weeks were developed using a random sample of 70% of the wounds and validated in the remaining data. Results: A total of 365,659 (58.9%) wounds were healed by week 12. The logistic and classification tree models predicted healing with an area under the curve of 0.712 and 0.717, respectively. Wound-level characteristics, such as location, area, depth, and etiology, were more powerful predictors than patient demographics and comorbidities. Innovation: The probability of wound healing can be predicted with reasonable accuracy in real-world data from EMRs. Conclusion: The resulting severity adjustment model can become the basis for applications like quality measure development, research into clinical practice and performance-based payment.

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“…Most of these studies assessed nurses' knowledge of wound care without providing a wider explanation of the related competence areas or requirements, or they focused on specialist wound care nurses, so they were excluded. Five full texts were chosen of which three were research articles (Coleman et al, 2017;Cowman et al, 2012;Redmond, Davies, Cornally, Fegan, & O'Toole, 2016) and the remaining two full texts were document papers (Pokorná, Holloway, Strohal, & Verheyen-Cronau, 2017;Van Acker, Garoufalis, & Wilson, 2018).…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Also, a discursive study with wound care experts by Redmond et al () presented an educational package in wound care for undergraduate nurses. Finally, a consensus study of 17 experts by Coleman et al () focused on the development of a generic wound care assessment minimum data set for clinical practice but did not specify the areas of competence or requirements for registered nurses or podiatrists in wound care.…”

Section: Introductionmentioning

confidence: 99%

Competence areas for registered nurses and podiatrists in chronic wound care, and their role in wound care practice

Kielo

Suhonen

Salminen

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To identify general competence areas for graduating registered nurses and podiatrists providing chronic wound care. Background The provision of care for chronic wounds involves a team of multiple professionals, and registered nurses and podiatrists play an important role. However, previous studies have found that registered nurses have limited competence in wound care. In addition, there are no standardised international competence areas for the provision of chronic wound care by registered nurses and podiatrists. Design A qualitative design was used in this study. Methods The data were collected using six focus‐group interviews with the following professionals: (a) registered nurses; (b) authorised wound care nurses; (c) nurse educators; (d) physicians; (e) podiatrists; and (f) podiatry educators (N = 23). The data were analysed using inductive and deductive content analysis. COREQ guidelines were followed, See Appendix S1. Results The competence areas for registered nurses and podiatrists providing care for chronic wounds include knowledge, skills and performance in anatomy and physiology; aetiology, care and prevention of chronic wounds; and wound management and assessment. The competence areas also include a set of attitudes and values relating to chronic wound care and patients with chronic wounds. Conclusions In nursing and podiatry education and in working life, teaching should focus on these areas of competence in chronic wound care. This would standardise and integrate education on wound care, especially that of chronic wounds. Relevance to clinical practice Wound care is an important part of clinical practice in nursing and podiatry. It is suggested that registered nurses and podiatrists need general competence in chronic wound care to carry out evidence‐based, safe, high‐quality and cost‐effective care. These results could be used to define registered nurses’ and podiatrists’ competence areas and roles in evidence‐based wound care as independent healthcare professionals.

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Development of a generic wound care assessment minimum data set

Cited by 43 publications

References 27 publications

Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes

Cohort study evaluating pressure ulcer management in clinical practice in the UK following initial presentation in the community: costs and outcomes

Development of a Model to Predict Healing of Chronic Wounds Within 12 Weeks

Competence areas for registered nurses and podiatrists in chronic wound care, and their role in wound care practice

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