Study proves system heals wounds faster
Disease management/managed care
Study proves system heals wounds faster
Patients also required fewer nursing visits
Wound care can be a financial risk for home care agencies and health plans because of the poor clinical results that often persist even after months of nursing care. A recent pilot study of home health patients found that combining products that provide a better healing environment and a more structured wound care protocol reduces the time to wound closure by 52% and the total number of nursing visits by 63%. The total cost savings is more than $3,000 per patient.
Bayada Nurses Home Health Specialists of New Jersey in Morristown and Horizon Blue Cross/Blue Shield of New Jersey in Newark coordinated efforts to evaluate wound care outcomes in the home setting using both a traditional wound care treatment and the standard - ized Optimum Outcomes Wound Management System developed by Derma Sciences of Princeton, NJ.
"We were experiencing some stubborn wounds that weren’t healing. It seemed reasonable to do a small pilot study to try the Derma Sciences system," says David Bendich, MD, senior medical director for quality management for Horizon Blue Cross/Blue Shield. "The biggest problem was convincing doctors to try the system. Many were resistant at first. We went to the doctors to educate them. Finally, several agreed to try the system for patients whose wounds wouldn’t heal."
"The outcomes we achieved are important to us because of our need to work with managed care organizations," adds Donna J. Angelini, RN, clinical coordinator for Bayada. "Plus the program is of great value because of the changes in Medicare reimbursement. We are able to achieve superior outcomes in less time, which makes this very attractive in a capitated environment." (See box, p. 33, for outcomes data.)
The study included 20 patients with 25 wound sites. Those sites included 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 initially were 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.
The Optimum Outcomes Wound Manage ment System uses proprietary wound healing products containing zinc, vitamin B6, magnesium, vitamin A, and other elements that are carefully pH balanced.
System includes care plans, consultants
The wound management system also includes the following items:
• care plans and protocols for wound management, which 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, BS, MBA, vice president and chief operating officer of Derma Sciences. "The management system itself costs nothing," he adds. "Custom ers agree to buy our products, and we provide the training, the protocols, and the data collection mechanism."
"The products aren’t that much more expensive than other wound care products," says Bendich. "The small increase in product cost is more than justified. We brought wounds to closure that we didn’t expect to heal, and it took less time."
The Derma Sciences protocol requires much closer monitoring of wounds than many home health agencies traditionally provide, Angelini says. "But Derma Sciences was very supportive. They came into the agency and trained staff at all 26 service offices. They also provided good support services."
To ensure that wound care was consistent for the purposes of the comparison study, the same primary nurse visited patients in the study each Monday to provide care and monitor progress. "I think it makes a difference that each nurse followed the same wound protocol," she says. "We had everyone providing care the same way. In hospitals and home care, unless a very specific protocol is developed and followed, each nurse does things slightly differently, and that can affect outcomes." The Derma Sciences products are much easier for both nurses and patients to use properly, she adds. "The ease of use really adds to the attractiveness of the system. It’s much easier to teach families and patient how to use the Derma Sciences products than it is to teach them how to do a sterile wet-to-dry saline package. It means that families are more eager to participate in wound care, and we can discharge patients from nursing service quicker."
"The pilot study worked so well that when doctors call in with wounds, we tell them about the system," says Bendich. "Some doctors are still reluctant to agree to try it, but Bayada is willing to go out and speak with doctors and often convinces them to try the system."
"We have to convince doctors that what they’ve been doing doesn’t work. Many of the traditional dressings include chemicals that we think somehow actually kill growing tissue rather than promoting healing," he says. "These dressings do cost slightly more, but the difference in cost is minimal, and the outcomes speak for themselves."
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