Improving the Wound Care Patient Experience

Traditionally wound management quality metrics have focused on objective measures such as rate of wound healing, number of ulcer-free days, occurrence of infection, amputation rates, recidivism, and mortality. This information is obtained through data mining of electronic medical record (EMR) systems, but these outcome measures do not consider the patient experience.

The deficiency in patient feedback collection in the traditional outcome-based quality measures seen in the health care space has given rise to the development and deployment of patient-reported experience measures (PREMs). PREMs are a way of providing meaningful information that can guide quality improvement initiatives. PREMs facilitate direct feedback from patients through an objective process to drive improved clinical outcomes.

Care coordination, establishing/obtaining care, patient-provider interaction, and effective treatment delivery are other important drivers of processes. Additionally, interdisciplinary communication, encounter efficiency, provider availability, access to specialist referrals and testing, staff professionalism, visit convenience, and continuity of care are essential parts of our patient-centered approach. As such, clinicians should embrace potential opportunities to measure and improve quality of care in the chronic wound population we serve.

Patient surveys can be conducted in various ways including on paper with postage paid return envelopes, online with QR codes and URLs, and over the phone with 1-800 numbers. Surveys should be available in multiple languages to have utility in a diverse patient population. Obtaining input from the patient’s perspective about their wound healing journey supports innovations in personalized care, data-driven decision making, and helps to foster a more connected care continuum.

Having increased access to wound care–trained clinicians and clinical support teams is a key to successfully managing health care resources. Seamless care coordination and communication between the primary care providers and wound care specialists are vital parts of a successful outcome. Patients consistently report that effective coordination and communication among providers represent a critical and necessary foundation for high-quality wound care. Measuring patient satisfaction has proven to be an effective tool to improve patient engagement, foster patient loyalty, and support patient retention. Process measures are important assessments for healthcare delivery companies and providers alike. These performance processes help to achieve specific care delivery aims or avoid adverse events and poor outcomes. Taken together, PREMs can objectively incorporate the patient voice into quality assessment and provide detailed data capable of revealing systemic problems and guiding quality improvement interventions.
 
Acknowledging that each wound care patient journey consists of unique challenges, wound care clinicians care for the whole patient, not just the wound. Thorough patient assessments allow our clinicians to make an accurate and timely diagnosis of wound etiologies and identify a variety of local and systemic barriers to wound healing.

The importance of maintaining quality of life for patients suffering from chronic wounds cannot be overlooked. Chronic wounds often occur in patients with multiple other comorbidities. In many instances travel to multiple appointments can be challenging, because many disabled patients or patients with lower extremity chronic wounds are unable to drive and require special transportation arrangements, using either a caregiver or health care transport service. In some cases, lack of transportation availability or coordination resulted in delayed or missed wound care and potential complications.

Wound care clinicians must embrace ways to overcome these barriers by providing care to the patient in alternative locations such as at home or skilled nursing facilities. Patients report a greater satisfaction with treatments that are individualized to accommodate their comorbid disease, mental status, and social/caregiver needs. Consideration of patient-reported health-related quality of life outcomes and convenience of care remains a high priority for patients.

By tracking meaningful patient centered quality measures, clinicians can better address both patient outcomes and resource utilization which is imperative to improving value in wound management. By augmenting quality measures that rely on administrative data with PREMs wound management will shift away from individual provider/encounter-based evaluations to a more longitudinal assessment of quality, which is especially important for patients with chronic wounds. As health care providers, payers, and policymakers seek to improve quality and value of care in the chronic wound population, efforts must focus on tracking PREMs to complement traditional objective outcome measures.

The future of wound management must be committed to creating a patient-centric wound care ecosystem to drive payers, providers, patients, and other stakeholders to think differently about how the business of wound care is conducted.

Dr. Cole is an Adjunct Professor and Director of Wound Care Research at Kent State University College of Podiatric Medicine. She is the National Director of Clinical Safety Quality and Education for Woundtech.