:﻿wound healing outcomes: the impact of site of care and patient stratification.
﻿ 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.


OBJECTIVE
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 January 2006 through April 2007 in a prospective, longitudinal, intent-to-treat, cohort study. Results were compared to prior sub-acute care wound outcomes reported by a similarly composed team using similar protocols.


RESULTS
Of 101 evaluable patients with 209 wounds, 41.6% healed in a median of 7.9 weeks while 31.6% achieved > 50% volume reduction. Outcomes were similar to prior sub-acute results, but less than the 72%-74% healing rate reported by a similar team in hospital outpatient clinic programs. Minimum Data Set comorbidities analyzed did not significantly predict nonhealing.


CONCLUSIONS
To allow risk-adjusted P4P and reimbursement metrics, wound outcome reports should include clinical team involved, protocol utilization, care setting, and case mix severity to control for variables associated with different settings.
St. James Hospital, Olympia Fields, IL; Email: wtc211@pol.net.
William J
WJ
Ennis
Emily
E
Fibeger
Katie
K
Messner
Patricio
P
Meneses