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Not Skin Deep: Lower Costs and Better Outcomes in Wound Care

December 20, 2013
by John DeGaspari
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Evidence-based wound care makes a big difference at one Canadian provider organization

Wound care is a significant and rising healthcare cost. In the U.S. alone, chronic wounds affect 6.5 million patients annually, at a cost in excess of $25 billion, according to the National Center for Biotechnology Information. Those costs may well rise, given the aging population and the increase in the incidence of diabetes.

The troubling statistics are representative of other geographic regions as well. Yet in Canada, the Toronto Central Community Care Access Centre (TC CCAC), a branch of the Ontario Ministry of Health and Long-Term Care that serves 1.5 million residents, has achieved significantly higher adherence to best practices in wound care, resulting in much lower readmission rates and costs compared to Canadian national averages. CCAC worked with Mississauga-based Calea Home Care, a provider of wound care management services to the agency, in an effort to improve outcomes and lower costs. Karen Laforet, R.N., director of clinical services at Calea, says those results were achieved by having near-real-time data that is used in a variety of ways to achieve those results.

(The data is provided via a solution, called how2trak, supplied by Health Outcomes Worldwide, New Waterford, Nova Scotia. According to the vendor, the Wound Care Module provides clinical data related to wound management, allowing clinicians and managers to track patient outcomes and clinical wound management practices, and providing benchmarking and comparison reporting of provincial and national benchmarks related to evidence-based targets. Calea uses the desktop version of the software, although a mobile app has recently been introduced. In addition to wound care, versions have been developed for diabetes and surgical site infection surveillance.)

Calea and CACC have worked out an implementation plan to monitor and analyze treatment-critical outcome metrics, including: adherence to evidence-based, best practice care; wound closure rates in isolation and in comparison to benchmarks cited in literature; existence of co-morbid conditions; product usage; and resource allocation rates related to nursing time and product use.

Calea implemented the data management solution in 2009, about six months before Laforet’s arrival there. She says that the implementation has allowed Calea to stay ahead of the curve on Canadian government demands for more outcome-based pathways, including clinical performance, average length of stay and time for healing.

Laforet notes several benefits of the system, topmost among them continuity of care. Observing that nurses work 12-hour shifts and don’t come in every day, she says it’s likely that the patient will not see the same nurse through his or her treatment. Each nurse who is involved with a particular patient’s care can pull up the patient’s record electronically to view the treatment decisions and the wound status.

The system provides real-time data in terms of pictures of the photos and wound measurements. It can accept photos from an iPhone or Android device, allowing nurses to gauge healing, and enter data on the length and depth of the wound in an electronic form. The data can be used to generate a graphical visual representation of the healing progress. An encrypted, detailed report of the patient’s wound care can be sent electronically to the patient’s physician as well, Laforet says.

According to Laforet, the information allows her to track how long and how many resources are being used to provide care, as well as product use, cost of care, nurse time and medical supplies. “I can look at that individually, by patient population, wound type, by clinic, and globally,” she says, adding that the information has enabled the organization to lower its costs. Calea does not yet have an electronic health record, but she says it has a goal to use electronic forms as much as possible. She does spot audits, and says the information on the electronic charts is highly accurate.

Laforet adds that the data allows her to compare Calea’s performance against national measures. For example, 90 to 100 percent of its patients with venous leg ulcers (VLUs) receive compression therapy, a “gold standard” for evidence-based care, across Calea’s seven clinics. This is the highest rate in Canada, which has a national average of 60 percent compliance. She says the data has allowed her to put together a comprehensive evidence-based program for her patient population. “When I first started, we were only hitting 70- to 80-percent compression,” she says.

She adds that Calea has significantly lowered its readmissions rates for VLU wounds. “We did a retrospective analysis, and found that 7 percent of our patients returned within eight weeks, versus 31 percent in other care settings. That’s huge,” she says.

She adds: “That comparative analysis is really valuable, because it helps us set quality indicators and performance standards, and measured by them, so you are basically comparing apples to apples,” which would not have been possible with a system developed in-house that would not have access to that wider data.

Calea has also achieved the following results:

  • on average, wounds heal in 4.65 weeks;
  • average number of nursing visits is 10 per month, compared to 21 per month by other organizations in the province; and
  • it exceeded its goal of decreasing the overuse of anti-microbial wound dressings to an appropriate 10- to 15-percent use level.

Laforet says she is fortunate to have a core group of nurses who are well-trained, and the evidence-based program reinforces education of wound pathology and treatment, and support for the patient’s healthcare management.