What you put IN the patient may be as important as what you put ON them
I have been focusing more on nutrition with my patients. It’s one of those things we know we are supposed to address, but often we are not quite sure HOW. Susan Horn and I spent months developing the Wound Healing Index, a suite of mathematical models that can predict the likelihood of wound healing. We looked at both patient and wound factors (in 50,000 wounds), and in 6 of 7 wound types, nutritional status was a major factor in predicting whether a wound would heal. (The only category of wounds in which nutrition did not appear to be a significant factor were venous stasis ulcers.)
Read more about the WHI for pressure ulcers in this article published open source: http://journals.lww.com/aswcjournal/fulltext/2015/12000/A_Predictive_Model_for_Pressure_Ulcer_Outcome__The.8.aspx
When they asked the bank robber Willie Sutton why he robbed banks, he replied, “Because that’s where the money is.” If you want to find a malnourished patient, look in a wound center waiting room.
That is one of the reasons I was so excited when Nestlé sponsored a nutritional screening quality measure for patients with wounds using a validated tool like the Mini Nutritional Assessment (MNA). The USWR now has 2 nutritional screening measures which can be reported under MIPS, one that is provider reported, and one that is patient reported. Read more about the measures here: https://uswoundregistry.com/qualitymeasures
On Saturday September 9, at the upcoming APWCA meeting, I will be discussing how practitioners can avoid losing 4% of their Medicare Part B payments by performing a Clinical Practice Improvement Activity (IA) focused on nutritional screening of patients with wounds, and prescribing appropriate supplements.