Quality versus Saving: Outcomes and Indicators to Wound Care

Paulo Alves RN, MSc, PhD1

Assistant Professor - Institute of Health Sciences, Universidade Católica Portuguesa

The prevalence of wounds in community and health facilities is not fully known; while managing costs of treatment is insufficient. To characterize this phenomenon we decided to study the bearer of wounds, epidemiology and costs associated with their treatment in community and hospital care. The wounds were grouped according to the aetiology and chronicity; and, characterized by location, origin, time of existence, pain, surrounding skin and infection. It also estimated the direct costs of treatment, type and context of care. We will discuss the importance and relation of the selection of the dressing material for wound treatment, facing the problem quality versus saving and quality indicators.

From the 108 840 users surveyed, 5274 had wounds, corresponding to a wound prevalence of 4.84% in the observed users and an estimated wound prevalence of 3.3 patients per 1,000 inhabitants in Portugal. Chronic wounds represented an estimated prevalence of 1.6 / 1000 inhabitants. As for the patient with a wound, the most significant risk factors associated were hypertension and diabetes (23%). Were also identified: infection rate in the deep tissues in almost 18% and wound pain in 66%; The time of existence of a wound averaged 189 days, being significantly higher in chronic wounds than acute wounds. The mean duration of treatment was evaluated and the average cost estimated was significantly higher in chronic wounds compared to acute wounds.

We have identified some gaps in clinical practice, diagnosis and characterization; also outcomes were inadequately covered demonstrating the need to define clear and objective indicators to evaluate clinical practice and Quality improvement.  Further research priorities to inform clinical practice will be also discussed.

 

References:

Gottrup, F., Apelqvist, J., & Price, P. (2010). Outcomes in controlled and comparative studies on non-healinhg wounds: recommendations to improve the quality of evidence in wound management. Journal of Wound Care , 1-30.

Gunningberg, L., Stotts, N. A., & Idvall, E. (2011). Hospital-acquired pressure ulcers in two Swedish County Councils: cross-sectional data as the foundation for future quality improvement. International Wound Journal, 8(5), 465-473. doi:10.1111/j.1742-481X.2011.00818.x

Posnett, J., Gottrup F, Lundgren H & Saal G. (2009). The resource impact of wounds on health-care providers in Europe. Journal Wound Care , 154-61.