Holistic wound center takes DM approach

Addressing underlying conditions speeds healing

In just two short years, the Jefferson Regional Medical Center Wound Care Center in Jefferson Hills, PA, has achieved impressive net revenues and recorded a healing rate nearly twice as fast as that achieved through conventional wound care.

What sets the center apart is the holistic, interdisciplinary approach to wound care taken by Curative Health Services, a leading disease management company in the field of chronic wound care based in Hauppauge, NY, that is partnering with Jefferson Regional Medical Center in this endeavor. Jefferson Regional is a member hospital of VHA Inc., an Irving, TX-based nationwide network of community-owned health care systems and their physicians.

"We take a care management approach using a proven clinical pathway that emphasizes a holistic approach to patient management," explains Melissa Weimer, MS, the center’s program director employed by Curative.

Curative’s approach is aptly described as disease management, she explains, because it addresses the four underlying diagnoses that prevent healing quickly.

"Normal wound healing occurs within four to six weeks," she notes. "When wounds don’t heal in that time, complications due to diabetes is the most common cause. Other causes include venous insufficiency, poor circulation, and pressure ulcers in compromised patients."

The Curative approach entails looking into different aspects of the patient’s lifestyle and support system. "It is a total patient concept," Weimer says. "Is the patient living alone? What’s the nutritional status? Are there significant others to provide care between visits?"

Home-grown center evolves

In the late 1990s, Jefferson Regional treated wound patients utilizing the services of one nurse, whose treatment options were limited; physician follow-up was intermittent.

"Wounds were treated as acute care conditions," Weimer says. "There was a very limited window of time to treat the wound, and patients often were discharged before any protocol could be established." The clinic cost the hospital more than it earned, and healing rates were lower than expected.

A disease management approach, by contrast, incorporates protocols and clinical pathways that start by identifying the wound etiology, she adds. The wound care centers in Curative’s network, Weimer says, are "comprehensive outpatient centers designed to complement physician services. Physicians refer patients for aggressive, outcome-based wound management." The centers treat nonhealing wounds that have not shown significant improvement under standard care.

The new, designated outpatient clinic includes six exam rooms, in operation Monday through Friday, with a panel of five physicians who have set clinic hours each week. "They are already credentialed at Jefferson Memorial, and they had a keen interest in being involved in this center," says Weimer. "They have to stay current with the newest technologies and approaches." The staff also include 10 part-time nurses from the hospital and a front-office assistant.

Jefferson contracted with Curative in 2000 to manage its wound care program. Along with its pathways, Curative offers an extensive outcomes database, reimbursement support, and community and medical education.

From the start, the interdisciplinary approach involves the patient’s primary care physician. "We depend on them for baseline information, and the treatment plan is prescribed with the wound care physician," Weimer says. "We photograph and measure wounds each week. If it heals appropriately, we know the patient is following the prescribed recommended treatments. Within two to three weeks, we can assess if the treatment plan is effective." If the wound healing is not progressing as expected, changes to treatment plans may be implemented, she explains.

The Curative approach includes several key areas of focus:

Patient education.

This covers patient compliance in terms of nutrition, follow-up instructions, and patients’ commitment to maintaining their own health for the best healing potential, be it quitting smoking, eating correctly, or controlling sugar intake. In addition, patients are encouraged to keep their weekly appointments throughout the 14-week program to keep them compliant with their treatment protocols.

Home care services coordination.

This supplements weekly visits to the wound care physician. "We use home health agencies as our eyes and ears in the field for our docs," says Weimer. "Since patients are seen by our physicians during each visit, their treatment plan may change, so home care nurses can instruct patients on changes in their care plan."

Prevention.

"Our rate of recidivism is very low," she points out. "If patients do return, it’s because of health conditions beyond their control, i.e., chronic venous or arterial disease. Our patient education helps prevent recurrence and creates awareness so the patient may contact the Wound Care Center earlier if a new wound occurs."

As part of Curative’s network of approximately 100 centers and a database of over 350,000 wound cases, Jefferson receives a set of benchmarks that cover such measures as days to healing, patient satisfaction, and percentage of healed patients.

Within the first year of operation, the center reported that 91.6% of the 454 patients who completed treatment were healed within 37 days — nearly twice as fast as with conventional wound care. Patient satisfaction levels are 97.5% — and in its second year, the center achieved $1.1 million in net revenues from operations and direct expenses totaling $834,000, or a 29% direct margin.

Need More Information?

For more information, contact:

• Melissa Weimer, MS, Program Director, Jefferson Regional Medical Center Wound Care Center, 575 Coal Valley Road, Suite 207, Jefferson Hills, PA 15025. Phone: (412) 469-7676. E-mail: mpweimer@jeffersonregional.com.