Home-Based Advanced Wound Services: Changing the Model of Care

Advances in modern medicine have improved life expectancy. The US national life expectancy in 2019 was estimated to be 78.8 years of age.¹ A downside to this increased longevity is the greater risk of chronic systemic diseases. Patients are living with multiple comorbidities, and many are taking numerous medications. The US Centers for Disease Control and Prevention reported that the 5 leading causes of death in 2019 in persons 65 years or older were as follows: heart disease, malignant neoplasms, respiratory diseases, cerebrovascular disease, Alzheimer disease, and diabetes.¹ Chronic, nonhealing wounds associated with these conditions are also increasing in prevalence.²

Chronic wounds are not typically problematic in a healthy patient population. However, persons become predisposed to the development of nonhealing wounds when advancing patient age is paired with numerous underlying conditions, such as heart disease and metabolic syndromes, systemic stresses, and malnutrition. Hard-to-heal wounds negatively impact patient well-being and create a significant cost to the health care economy. A 2018 retrospective analysis identified that approximately 8.2 million Medicare beneficiaries had developed wounds with and without infections.³ The estimated cost to Medicare for treating acute and chronic wounds ranged from $28.1 billion to $96.8 billion.³ Surgical wounds and diabetic ulcers drove the highest total wound care costs.³ Hospital outpatient services, such as wound care centers, steered the greatest proportion of costs.³ The document also highlighted a major shift in site-of-service costs from hospital inpatient to outpatient settings.³

Not only are chronic wounds increasingly costly to treat, they also often result in significant pain, anxiety, isolation, depression, and reduced quality of life. Despite these negative factors, there are often multiple hurdles inherent in this population that prevent access to advanced wound care services. The paucity of wound care-certified clinicains in rural and suburban areas, advancing patient age, limited mobility, lack of transportation, insurance restrictions, and socioecomonical factors are just a few of the obstacles facing this at-risk patient population.

The demand for advanced wound care will continue to grow as the population older than 65 years is projected to increase by 25% by 2060.^4,5 Fundamental changes in how advanced wound care is delivered to this aging population are necessary to keep pace with increasing demand.

PROACTIVE APPROACH TO CARE

I recently took on a new role as the Director of Clinical Education and Professional Development at Woundtech, a national company providing advanced wound care services. The model of care is a proactive approach to advanced wound care services that reduces overall health costs while increasing patient access by delivering care in their home. Podiatrists, nurse practitioners, and physician assistants comprise the Woundtech field clinician team. These clinicians provide high-quality, community-based, and patient-centered wound services.

In general, wound care clinicians can have diverse training, experience, and background, which can lead to inconsistent care and poor outcomes^6,7; poor-quality care is costly to the patient and the health economy.⁷ The development of chronic hard-to-heal wounds is multifactorial. Common factors contributing to delays in wound healing include underlying pathology and comorbidities, local factors, wound size and duration, wound location, and overall patient health. Chronic wounds develop more complications such as infections, which can result in the need for costly interventions such as hospitalizations, surgeries, or amputations. The rigorous clinical training provided to Woundtech clinicians establishes a core standard for wound management to decrease the negative sequelae associated with chronic wounds.

Woundtech advanced practice clinicians are trained extensively in evidence-based clinical practice protocols specific to various wound etiologies. In addition to completing a company-developed, 5-hour advanced wound training course as part of the onboarding process, clinicians participate in weekly continuing wound care education. Relevant local and systemic factors guide wound care treatments, resulting in a more complete, patient-focused, sustainable wound management model.

This model of care can help expedite patient referrals through a patient care coordinator and case management support departments to speed early hospital discharge by scheduling prompt starts of care. The key to effective wound management is early intervention. Delays in care can result in higher health care costs and poor patient outcomes. Patients may also qualify for enrollment in dedicated telehealth service or long-term care pathways when indicated. In addition, unlike traditional home health care service providers, WoundTech advanced practice clinicians can perform procedures such as debridement and negative pressure device applications, write orders for medications and testing, and coordinate patient referrals.

Proper dressing selection remains the mainstay of wound therapy. Woundtech clinicians have access to an extensive formulary of advanced dressing options. Dressing selection is based on detailed patient and wound assessments, underlying cause, objectives of treatment, wear time, and cost-effectiveness. Research has shown that dressing availability and selection can substantially influence time to wound healing.⁸

ADDITIONAL FACTORS

Over the past decade, health care technology has helped transform care delivery. Woundtech boasts a company-specific electronic medical record that allows for robust clinical data capture and aids in treatment decision-making. Using evidence-based clinical algorithms configured with proprietary sequential assisted logic and clinical alerts, machine learning, and artificial intelligence, precision wound care is being taken to new levels.

The United States is facing a shortage of health care workers in many locations. Hospitals are stretched thin as beds are again filling with patients with COVID-19. A proactive model of care that provides wound services in the patient’s home provides valuable care to at-risk populations and lessens the burdens on hospitals.

CONCLUSION

Many of the challenges of wound care can be lessened or eliminated by employing well-trained advance practice clinicians to provide wound care to patients in their homes. Embracing alternative places of service outside hospitals or clinics can decrease the strain on the medical system and ensure health equity and better patient outcomes. Creating new, successful models of care is essential.

Dr Cole is the Director of Wound Care Research, Kent State University College of Podiatric Medicine, Kent, OH, and National Director of Clinical Saftey, Quality, and Education for Woundtech. The opinions and statements expressed herein are specific to the respective author and not necessarily those of Wound Management & Prevention or HMP Global. This article was not subject to the Wound Management & Prevention peer-review process.

REFERENCES

1. Kenneth D, Kochanek MA, Jiaquan Xu, Arias E. Mortality in the United States, 2019. NCHS Data brief no. 395. Hyattsville, MD: National Center for Health Statistics. December 2020.

2. Sen CK. Human wound and its burden: updated 2020 compendium of estimates. Adv Wound Care. 2021;10(5):281-292. doi:10.1089/wound.2021.0026

3. Nussbaum SR, Carter MJ, Fife CE, et al. An economic evaluation of the impact, cost, and Medicare policy implications of chronic nonhealing wounds. Value Health. 2018;21(1):27-32. doi:10.1016/j.jval.2017.07.007

4. Sen CK. Human wounds and its burden: an updated compendium of estimates. Adv Wound Care (New Rochelle). 2019;8(2):39-48. doi:10.1089/wound.2019.0946.

5. US Census Bureau. Older people projected to outnumber children for first time in U.S. history. March 13, 2018. Revised September 6, 2018 and October 8, 2019. US Census Bureau; 2018. https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html

6. Williams EM, Deering S. Achieving competency in wound care: an innovative training module using the long-term care setting. Int Wound J. 2016;13:829-832. doi:10.1111/iwj.12388

7. Corriveau G, Couturier Y, Camden C. Developing competencies of nurses in wound care: the impact of a new service delivery model including teleassistance. J Contin Educ Nurs. 2020;51(12):547-555. doi:10.3928/00220124-20201113-05

8. Vowden P. Hard-to-heal wounds made easy. Wounds Int. 2011;2(4):1-6.