title: Guideline concordant venous ulcer care predicts healing in a tertiary care Veterans Affairs Medical Center.
abstract: This study describes the impact of 80% adherence to guideline concordant care for compression therapy, moist wound-healing environment, and debridement on venous ulcer outcomes. The retrospective cohort design included patients from a tertiary care Veterans Affairs Medical Center from October 2003 to September 2007. During this 5-year interval, 155 patients with 400 venous ulcers met study inclusion. A majority of ulcers (n=362) healed, with an average time to healing of 18.1 weeks (range 2-209 weeks, median 10.4 weeks). From the multivariate Poisson regression, the likelihood of ulcer healing increased when compression therapy was provided during at least 80% of visits (relative risk [RR], 1.93; 95% confidence interval [CI], 1.27-2.92) or when a moist wound-healing environment was provided during at least 80% of visits (RR, 1.63; 95% CI, 1.09-2.42). Debridement alone was not significantly associated with ulcer healing (RR, 1.0; 95% CI, 0.61-1.64). Patients who received all three treatments during at least 80% of their visits were more likely to heal than those who received < 80% treatment (RR, 2.52; 95% CI, 1.53-4.16). Guideline concordant venous ulcer care was significantly associated with venous ulcer healing, when provided at 80% or more of patient visits.
authors.affiliation: Department of Veteran's Affairs, Health Services Research and Development, Seattle, WA 98101, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Olson
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Raugi
authors.forename: Viet Q
authors.initials: VQ
authors.lastname: Nguyen
authors.forename: Onchee
authors.initials: O
authors.lastname: Yu
authors.forename: Gayle E
authors.initials: GE
authors.lastname: Reiber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001458:Bandages; D015331:Cohort Studies; D003646:Debridement; D005260:Female; D019983:Guideline Adherence; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D053828:Stockings, Compression; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000628:therapy*; D014945:Wound Healing