title: Evidence-based chronic ulcer care and lower limb outcomes among Pacific Northwest veterans.
abstract: Evidence-based ulcer care guidelines detail optimal components of care for treatment of ulcers of different etiologies. We investigated the impact of providing specific evidence-based ulcer treatment components on healing outcomes for lower limb ulcers (LLU) among veterans in the Pacific Northwest. Components of evidence-based ulcer care for venous, arterial, diabetic foot ulcers/neuropathic ulcers were abstracted from medical records. The outcome was ulcer healing. Our analysis assessed the relationship between evidence-based ulcer care by etiology, components of care provided, and healing, while accounting for veteran characteristics. A minority of veterans in all three ulcer-etiology groups received the recommended components of evidence-based care in at least 80% of visits. The likelihood of healing improved when assessment for edema and infection were performed on at least 80% of visits (hazard ratio [HR] = 3.20, p = 0.009 and HR = 3.54, p = 0.006, respectively) in patients with venous ulcers. There was no significant association between frequency of care components provided and healing among patients with arterial ulcers. Among patients with diabetic/neuropathic ulcers, the chance of healing increased 2.5-fold when debridement was performed at 80% of visits (p = 0.03), and doubled when ischemia was assessed at the first visit (p = 0.045). Veterans in the Pacific Northwest did not uniformly receive evidence-based ulcer care. Not all evidence-based ulcer care components were significantly associated with healing. At a minimum, clinicians need to address components of ulcer care associated with improved ulcer healing.
authors.affiliation: Department of Veterans Affairs, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington.|School of Medicine, University of Washington, Seattle, Washington.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Karavan
authors.affiliation: School of Medicine, University of Washington, Seattle, Washington.|Division of Dermatology, University of Washington, Seattle, Washington.
authors.forename: John
authors.initials: J
authors.lastname: Olerud
authors.affiliation: Department of Veterans Affairs, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington.|Departments of Health Services and Epidemiology, University of Washington, Seattle, Washington.
authors.forename: Erin
authors.initials: E
authors.lastname: Bouldin
authors.affiliation: Department of Veterans Affairs, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington.
authors.forename: Leslie
authors.initials: L
authors.lastname: Taylor
authors.affiliation: Department of Veterans Affairs, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington.|Departments of Health Services and Epidemiology, University of Washington, Seattle, Washington.
authors.forename: Gayle E
authors.initials: GE
authors.lastname: Reiber
mesh_terms: D000368:Aged; D002908:Chronic Disease; D058128:Compression Bandages; D003646:Debridement / Q000379:methods*; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007871:Leg Ulcer / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D015205:Northwestern United States / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014728:Veterans; D014945:Wound Healing
keywords: evidence-based care; lower limb; ulcer; veterans