Leg-ulcer care in the community, before and after implementation of an evidence-based service.
BACKGROUND
Leg ulcers usually occur in older patients, a growing population for which increasing health care resources are required. Treatment is mainly provided in patients' homes; however, patients often receive poorly integrated services in multiple settings. We report the results of a prospective study of a community-based care strategy for leg ulcers.


METHODS
International practice recommendations and guidelines were adapted to make a new clinical protocol. The new model, for a dedicated service staffed by specially trained registered nurses, established initial and ongoing assessment time frames and provided enhanced linkages to medical specialists. Data were collected for 1 year before and after implementation; outcome measures included 3-month healing rates, quality of life and resource usage.


RESULTS
Three-month healing rates more than doubled between the year before implementation (23% [18/78]) and the year afterward (56% [100/180]). The number of nursing visits per case declined, from a median of 37 to 25 (p = 0.041); the median supply cost per case was reduced from 1923 dollars to 406 dollars (p = 0.005).


CONCLUSIONS
Reorganization of care for people with leg ulcers was associated with improved healing and a more efficient use of nursing visits.
Harrison
Margaret B
MB
School of Nursing, Queen's University, Kingston, Ont. harrisnm@post.queensu.ca
Graham
Ian D
ID
Lorimer
Karen
K
Friedberg
Elaine
E
Pierscianowski
Tadeusz
T
Brandys
Tim
T
D019033:Delivery of Health Care, Integrated; D019468:Disease Management; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006295:Health Resources / Q000706:statistics & numerical data; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007871:Leg Ulcer / Q000628:therapy*; D011446:Prospective Studies; D011788:Quality of Life