Monday Musings

How can we get out of this silly problem of trials that don’t enroll our patients to get coverage for patients who really don’t need the product anyway? We need a way to risk stratify wounds that includes patient factors. Thanks to partial funding from a grant by KCI (now Acelity), US Wound Registry data was used to create the “Wound Healing Index” in a product we did in conjunction with Susan Horn from the Institute for Clinical Outcomes Research. There are actually 7 models, one for each major wound type.

WHI_LogoThe WHI is the statistical likelihood of a wound becoming healed. Here is the list of questions you would need to answer to use the diabetic foot ulcer WHI. We have programmed the WHI into the Intellicure EHR so it isn’t necessary to answer specific questions. This allows us to report outcomes for Intellicure users, stratified by WHI, for the doctors participating in the US Wound Registry Qualified Clinical Data Registry (QCDR). In honor of Columbus Day, we are discovering the New World of risk stratification for wound care patients. It’s about time, given that risk stratification has already been discovered by every other specialty except US.

Number / Question

  1. Patient age in years (calculated from date of birth) at first treatment
  2. Wound age (duration) in days (calculated from wound onset) at first encounter
  3. Wound area in cm2 (calculated from length x width) at first encounter
  4. What is the patient’s primary ambulatory method? (walks unaided, cane, crutches, walker, roll about, scooter, wheelchair bound, bed bound)
  5. Was the patient admitted to the hospital or the emergency department on the date of service?
  6. How many total wounds or ulcers of any type does the patient have?
  7. Does this wound have evidence of infection or bioburden? (evidenced by: purulent, green, malodorous drainage, peri-wound induration, tenderness to palpation, warmth)
  8. Is the patient on dialysis or status post renal transplant?
  9. What is the Wagner Grade of the ulcer (1-5)?
  10. Does the patient have peripheral vascular disease (claudication, rest pain, abnormal arterial vascular studies, loss of pulses)?

Caroline Fife, MD

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