Benchmarking Chronic Wound Healing Outcomes
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Index: WOUNDS 2012;24(1):18–24
Abstract: Background. Benchmarking chronic wound outcomes (comparing outcomes achieved in practice to those reported elsewhere) begins with documenting and summarizing individual and cohort outcomes of one’s practice, continues with searching for comparable results, and is completed by improving care if benchmark outcomes exceed one’s own. Objective. Literature reviewed illustrated this cycle of document-summarize-search-compare outcomes of a recognized healing measure—percent completely healed within 12 weeks of care. Methods. MEDLINE and Association for the Advancement of Wound Care (AAWC) Venous and Pressure Ulcer Guidelines and Evidence Table searches identified example healing benchmarks from randomized controlled trials (RCTs) with 100 subjects/group with a diabetic foot ulcer (DU), venous leg ulcer (VU), or pressure ulcer (PU). Graphed benchmarks were compared to outcomes reported for same-etiology cohorts to illustrate institutional and patient-level benchmarking. Results. Cohorts in some settings reported results similar to the best RCT results for DU and VU. More adequately powered PU RCTs are needed to provide full- and partial-thickness PU benchmarks. RCTs have strengths and limitations as benchmarking resources. Risk-adjusted analyses would improve benchmarking. Conclusion. Documenting and comparing outcomes to published results can support current interventions, highlight opportunities for improvement, or ensure that interventions applied are working to meet individual patient and wound care goals.
Clinicians use wound care outcomes every day to A) document and report results of care providing feedback to professionals that can improve results1; B) monitor progress toward achieving clinical and patient-oriented goals, keeping patients on the path to healing, and C) choose interventions with best available evidence of efficacy in achieving desired goals of patient and wound care (Figure 1). The third step is called benchmarking, which means using published wound outcomes reported by others as a framework within which to assess their own outcomes and potential need for improved care. Benchmarking begins with documenting and summarizing individual and cohort outcomes of one’s own practice, continues with searching for results on similar patients, and is completed by improving care if the benchmark outcomes exceed one’s own.
A recognized chronic wound healing outcome2—percent of wounds completely healed after 12 or more weeks of care—was used to illustrate benchmarking in clinical practice. Example published healing benchmarks for venous ulcers (VU), pressure ulcers (PU), or diabetic foot ulcers (DU) were summarized to provide a framework within which to evaluate individual or institutional outcomes of care to assess needs for improvement.
The MEDLINE reference database and the Evidence Tables for the AAWC Venous3 and Pressure4 Ulcer Guidelines were searched for examples of randomized controlled trials (RCTs) reporting percent of DU, PU, or VU completely healed during at least 12 weeks of care as an example of a commonly reported healing outcome. MEDLINE search terms included: “heal” and “topical” and “random” and [“chronic wound” or venous ulcer or pressure ulcer or diabetic ulcer”]. The AAWC Venous and Pressure Ulcer Evidence Tables were searched using the “Find” function in Microsoft® Word software, and using “heal” as the search term.