As healthcare providers prepare for pay for performance (P4P) and outcomes-based reimbursement strategies, it is increasingly important to document clinical results. Historically, healing rates have been reported from hospital-based, outpatient wound clinics. Time-to-healing curves from one site of care may not accurately reflect the entire healing “episode of care.” Few outpatients from a wound clinic require hospitalization and even fewer are admitted to sub-acute care. Care setting and population risk strata must be clearly identified before comparing wound outcomes data. Aim. Primary objectives were to determine comparability of complete healing and 50% wound volume reduction of current and prior sub-acute care programs. Predictive value of Minimum Data Set (MDS 2.0) items on admission was also explored in discriminating healing versus nonhealing patients. Methods. Wound outcomes were analyzed for all patients (N = 101) treated at a dedicated sub-acute wound unit from

Chronic cutaneous wounds include leg ulcers, pressure ulcers, and diabetic foot ulcers. Each of these conditions is difficult to heal within an acceptably short time, and to maintain as healed. Patients suffer tremendous discomfort and pain, and are often socially deprived as a result. The financial consequences of this medical problem are enormous. Chronic or nonhealing ulcers are characterized by defective remodeling of the extracellular matrix, a failure to reepithelialize, and prolonged inflammation. In order to obtain biochemical and physical information about the wound bed and the surrounding skin, different options of noninvasive and invasive measurements have been developed and tested. Monitoring of acute and chronic wounds can be performed by measuring in an objective, precise, and reproducible way and by simply adapting existing validated technologies. When speaking of cutaneous wounds, one refers to defects in the skin surface. It is generally believed that a f

Measured outcomes can help assure successful implementation of evidence-based wound care programs by informing patients, professionals, and payors that a health care system is both efficient and effective. Objective. Illustrate how clinical and economic outcome measurement was important to ensure sustainability of standardized evidence-based wound care programs implemented in Canadian community care. Methods. Client assessments, dressing change frequency, wound healing, and economic outcomes were measured on 16,079 Canadian home care clients, including 8089 with a total of 11,160 chronic or acute wounds during standardized evidence-based protocol implementation that involved education, knowledge transfer, strategic planning, management accountability/receptivity, communication, and either prospective client assessment-based data or retrospective chart audit data to measure outcomes. Results. Results from 3 regions illustrate how evidence-based protocol use decreased lengt

Measuring pressure ulcer outcomes for deep tissue injury (DTI) in pressure ulcers has improved the authors’ understanding of DTI. The authors’ multidisciplinary team has also identified previously unexplored patterns of tissue necrosis. Objective. Illustrate these new patterns of tissue necrosis and report their incidence in a hospital setting. Methods. Progressive tissue deterioration was explored using CT scans and ultrasonography of 326 Stage IV pressure ulcers with deep tissue injuries (DTI) managed by a multidisciplinary wound care team using standardized protocols of care in a Japanese hospital from June 2002 to June 2006. Results. Two new patterns of pressure ulcer necrosis were found and are illustrated. All patients were checked consecutively and treated by the multidisciplinary team every 2 weeks. Among the consecutive sample of 326 patients, 194 (60%) were common DTI with column-shaped necrosis, including 7 with relatively healthy tissue sandwiched between shal

Measuring and tracking wound complications and associated risk factors are powerful tools in managing wound outcomes. The authors review fundamental epidemiological approaches to clinical investigation, beginning with some basic study designs, and their relative strengths and weaknesses, with respect to the usefulness of the findings. Examples of methods to calculate rates and proportions and ways to measure significant change over time are presented. A conceptual model that is universally used by infection prevention professionals in the development and implementation of prevention strategies is also described. Risk stratification systems that have been derived through the analysis of thousands of patients are presented. These systems help predict those patients who are at risk for developing adverse outcomes (eg, infections or pressure ulcers), and therefore, should help caregivers address those risks by applying scientifically derived prevention strategies. Finally, va