Limitations of Daily Living Activities in Patients With Venous Stasis Ulcers Undergoing Compression Bandaging: Problems With
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Disclosure: Dr. Fife is Chief Medical Officer for Intellicure Inc. David Walker is President and CEO of Intellicure Inc.
Ulcers caused by chronic venous insufficiency constitute 70%–90% of all lower extremity ulcers.1,2 For more than 2 decades, compression bandaging has remained the gold standard of therapy,3 although only 50%–60% of venous stasis ulcers (VSUs) typically heal within 6 months and recurrence is common.4,5 High-technology products hold promise in accelerating ulcer healing for some patients,6 but do not address the fundamental problem—venous insufficiency.Compression will most likely not help those patients who have significant concomitant arterial disease. Nevertheless, until significant advances are made in this area, compression bandaging is likely to remain a standard clinical guideline.7
Medicare and insurance companies only cover the cost of compression stockings if an active ulcer is present, but not to prevent the formation of venous ulcers, even though the lifetime cost per quality-adjusted life year saved is < $60 000.8 Further, at least 1 regional Medicare carrier has suggested restricting reimbursement for the cost of compression bandaging at wound care centers, indicating that patients should be able to self bandage.9 This brief study sought to estimate how many patients with VSUs within a wound care setting would be unable to self bandage based on an activities of daily living (ADL) analysis.
Materials and Methods
Intellicure Inc (The Woodlands, Tex) maintains a research consortium agreement with its Level-4 electronic health record software users and permits an analysis of wound care visits in a HIPAA-compliant fashion. The dataset consisted of 7251 patients with all types of wounds (N = 16,856), which produced 119,134 patient encounters at 29 wound care facilities. Standard query language was used to ascertain: A) how many patients had ADL information; B) how many of these patients had VSUs (ICD-9 code 454.x); C) what percentage of these patients required assistance with ADLs or ambulation; and D) what types of limitations these patients had.
Results
Fourteen facilities used ADL assessments, and 547 patients with VSUs were identified with ADL data. The ADL results are shown in Table 1.
Discussion
References
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9. Noridian Medicare Web site. High compression bandage system billing clarification. Available at: https://www.noridianmedicare.com/cgi-bin/coranto/viewnews.cgi?id=EEZkpZFVEkcHbuZQLN&tmpl=part_b_viewnews&style=part_ab_viewnews. Accessed September 26, 2007.
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