Chronic Wound Healing In the Home: A Wound Care Pilot Program

Chronic wounds lead to considerable disability, reduced quality of life ans increased mortality. They are also associated with increased hospital admissions, clinical complications including amputations and co-morbid conditions such as depression. A multidisciplinary team was formed to identify an aggressive treatment plan for patients with non-healing/chronic wounds to improve healing. Literature and data were extensively searched to identify best practices with wound care. Data review revealed that approximately five (5) million Americans suffer with chronic wounds with four (4) million characterized as pressure ulcers and other types of wounds and one (1) million diabetic ulcers. It is estimated that treatment for chronic wound care range between $16 and $24 billion annually, nearly 5% of the total annual spending on Medicare and Medicaid combined (Cohen, Schultz et al, 2000). Three case mix profiles were identified for our home health agency for patient's with wounds: 33.8% surgical, 5.46% pressure ulcers, and 1.57% venous ulcers. Working with one of our major insurance providers, we identified that 7% of total claims were for wound care costing $45,609,882 annualy.

During the planning phase, the team developed treatment algorithms and wound care photo/data collection forms. Equipment was purchased and communication processes were developed. Our goals for the program were as follows:

• Increase healing rate of wounds. Expect to see a 40% reduction in wound size per month using evidenced based protocols
• Decrease number of amputations
• Improved patient compliance
• Decrease Emergency Room visit due to non-healing wounds
• Decrease impatient admissions

Fifty-eight patients were enrolled in the first year with most having multiple wounds for greater thats four (4) weeks duration. We demonstrated a 68.8% healing rate with the mean time of healing 58.5 days. 62.8% of the wounds showed > 50% of the wound was healed within 4 weeks of entry into the pilot program. Emergent care for wound infections decreased from 1.72% to 1.41%.