Wound program saves money, improves care

QI program scores marketing victory for NJ agency

Does the following list of woes sound hauntingly familiar? Managed care organizations demand hard data on outcomes. The prospective payment system promises to punish agencies carrying too many chronic cases requiring many visits. Patients increasingly demand more control over their care.

One agency found an opportunity to address each of these common home care issues with one dream-come-true program.

Bayada Nurses Home Health Specialists, of Morristown, NJ, found a wound care program that uses a more structured protocol and zinc-based wound care system to improve wound closure outcomes.

A pilot study resulted in savings of more than $3,000 per patient and wounds that closed 52% faster. Along with those results, the patients in the study — some of whom had unhealed wounds for more than two years — took more control of their own care and improved their quality of life. The agency was rewarded for its improved care by getting all of the wound care patients from one of its biggest contracts, Horizon Blue Cross/Blue Shield of New Jersey in Newark. (See chart below, for more data.)

Key Pharmaco-economic Data Optimum Outcomes Program

Prior Treatment
Regime (n=25)
Optimum Outcomes
Program (n=21)
Comparative Results
Clinical Components
Wounds Healed
4 (16%)
14 (66%)
410% increase
Average Time to Wound Closure
61 days
29 days
52% decrease
Economic Components
Average Cost per Healed Wound
$5,500
$1,825
67% decrease
Average Visits Per Healed Wound
68
25
63% decrease
Source: Bayada Nurses Home Health Specialists, Morristown, NJ.
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Bayada, which has 26 offices in seven states, faced the same problems with wound patients as other home care agencies.

"These patients tend to be older patients with a very slow healing process who are often plagued with comorbidities, such as diabetes or congestive heart failure," says Donna Angelini, RN, clinical coordinator for the agency. "We had patients who had been homebound for two years because of chronic draining craters," she says. "Our goal is to either heal these wounds, or at least make family members capable of caring for the patients independently."

When Princeton, NJ-based Derma Sciences approached Bayada to pilot its Optimum Outcomes Wound Management System, the idea was appealing.

"We are always looking for new programs to improve care and provide value to payers," says Angelini.

Bayada went to one of its largest payers, Horizon Blue Cross/Blue Shield, and asked if its patients could participate in the study. The payer agreed. Derma Sciences brought in its own ET (enterostomal therapist or wound care specialist) to present an inservice to Angelini and six nursing supervisors.

Along with information on the Derma Sciences products, the company presented an in-depth wound care protocol that Angelini says impressed her.

"They had things written out for every kind of wound and every disease process," she says. "It was written in a fashion that anyone could understand. Family members, after instruction, could use these sheets as a reference and be able to provide the care."

Three offices were chosen to pilot the program. Patients were randomly chosen. There was no opportunity to select only those patients with fresh surgical wounds, or without comorbidities.

Indeed, Angelini jokes that Horizon seemed to present Bayada with only the worst cases. When a patient was admitted, he or she was evaluated. Angelini then called the patient’s physician to explain the study and ask if the patient could participate. "About 80% of the doctors were receptive to it," she says. "Those who weren’t were wound care specialists with their own centers and protocols."

Dramatic results

The study included 20 patients with 25 wound sites. Those sites include Stage 2, 3, and 4 decubitus ulcers, dehiscence, stasis ulcers, ischemic ulcers, and surgical wound sites.

The physician and the home health nurse determined whether wounds were healing using a 14-point assessment tool. Patients were initially treated with the traditional treatment regimen. If the wound did not heal, the wound treatment was changed from the current treatment to the Derma Sciences system.

Elements for success

The Optimum Outcomes Wound Management System uses proprietary wound healing products containing zinc, vitamin B6, magnesium, vitamin A, and other elements that are carefully PH balanced. The system also includes:

• care plans and protocols for wound management that are wound specific;

• wound care education for nursing staff;

• wound care consultants for nursing staff support;

• data collection mechanism.

"The data collection tool collects clinical and economic information so the customer has a basis for comparison between their traditional wound care and our system," notes Richard Mink, MBA, vice president and chief operating officer of Derma Sciences. "The management system itself costs nothing. Customers agree to buy our products and we provide the training, the protocols, and the data collection mechanism."

The results for specific patients varied, but Angelini says some of the stories are amazing. She recalls one woman who had been hospitalized for a wound 12 times in eight months. When she wasn’t in the hospital, she was homebound. After entering the program, she had no hospitalizations and was able to leave home for the first time.

There were patients who hadn’t seen a change in their wounds for months, but saw improvement within a week of starting the program. Angelini says nurses would call her, amazed at the progress.

The faster healing and decreased visits initially meant less money for Bayada. However, there was a reward. Horizon, which previously referred its wound care patients to about six different agencies, started sending all such patients to Bayada for treatment.

"We lost income on the number of visits, but we gained referrals," says Angelini. Other payers are also starting to jump on the Optimum Outcomes bandwagon.

There were some associated costs to the program. Bayada paid market rates for the Derma Sciences products and there was increased paperwork.

"There is a weekly wound assessment sheet to be filled out, and a wound measurement to do every week," Angelini says. "I had to keep tabs on all these wounds and compile the data. While we aren’t tracking the data anymore, we still fill out the form. In fact, we have started using the form for all of our wound care patients, whether they are part of this program or not." There was also time spent on in-services to train staff.

However, any grumbling by the nurses was quieted as they saw the results of the new protocols. Angelini says it reinforced her belief that any wound care protocol is better than the older treatments, such as flushing with peroxide, some physicians still prescribe.

"I think that the more education people receive, the faster wounds will heal," she says. "A lot of physicians and surgeons don’t know about new modalities. This is an opportunity to educate them about something new. Anything is better than peroxide irrigation."

Along with the better care, faster healing, and increased referrals, Angelini thinks there has been another benefit to the program.

"I think that agencies have to develop special programs to stay marketable and relevant. This does that for us," she says. "Payers want pathways. They want programs for wound care, diabetes, or asthma. If you want to be successful, you have to have protocols and ways to measure outcomes. Everything is going that way; if you don’t do it, you will be left behind."