title: Cost-effectiveness of multidisciplinary wound care in nursing homes: a pseudo-randomized pragmatic cluster trial.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of a multidisciplinary wound care team in the nursing home setting from a health system perspective.
  
  
  METHODS
  Pseudo-randomized pragmatic cluster trial with 20-week follow-up involving 342 uncomplicated leg and pressure ulcers in 176 residents located in 44 high-care nursing homes in Melbourne, Australia in 1999-2000. Twenty-one nursing homes (180 wounds in 94 residents) were assigned to the intervention arm and 23 to the control arm (162 wounds in 82 residents). Residents in the intervention arm received standardized treatment from a wound care team comprising of trained community pharmacists and nurses. Residents in the control arm received usual care.
  
  
  RESULTS
  More wounds healed during the trial in the intervention arm than in the control arm (61.7% versus 52.5%, P = 0.07). A Cox regression with shared frailty predicted that the chances of healing increased 73% for intervention wounds [95% confidence interval (CI) 20-150%, P = 0.003]. The mean treatment cost was $A616.4 for intervention and $A977.9 for control patients (P = 0.006). Most cost reduction was obtained from decreases in nursing time and waste disposal. The mean cost saving per wound, adjusted for baseline wound severity and random censoring, was $A277.9 (95% CI $A21.6-$A534.1).
  
  
  CONCLUSIONS
  Standardized treatment provided by a multidisciplinary wound care team saved costs and improved chronic wound healing in nursing homes. The main source of saving was in the cost of nursing time in applying traditional dressings and in the cost of their disposal.
authors.affiliation: Centre for Health Economics, Monash University, Clayton, Victoria, Australia. trang.vu@buseco.monash.edu.au
authors.forename: Trang
authors.initials: T
authors.lastname: Vu
authors.forename: Anthony
authors.initials: A
authors.lastname: Harris
authors.forename: Gregg
authors.initials: G
authors.lastname: Duncan
authors.forename: Geoff
authors.initials: G
authors.lastname: Sussman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D004471:Economics, Nursing; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008485:Medical Audit; D009735:Nursing Homes; D003668:Pressure Ulcer / Q000191:economics / Q000451:nursing*; D014739:Victoria