Editor`s Opinion: A Stimulus to End Tradition-based Care

     In advance of the Symposium on Advanced Wound Care (SAWC) in April, the March issue of OWM traditionally includes a preview of exhibitors. This year is no exception. Included in this issue is an overview of the history of wound care practices and products that confirms what most advanced wound care professionals know — ie, regardless of research, the majority of wounds continue to be treated and dressed according to age-old practices.¹ For example, decades after the deleterious effects of gauze-type dressings were discovered and despite a plethora of available alternatives, most wounds are covered with gauze.

     Sadly, wound management is not the only healthcare area that remains behind the times. In its 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century,² the Institute of Medicine observed, “Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge — yet there is strong evidence that this frequently is not the case.” Similar observations and studies have led to recent changes in Medicare reimbursement for hospital-acquired conditions and are at the heart of the Health Information Technology (HIT) and the National Institute of Health (NIH) budget allocations included in the “American Recovery and Reinvestment Act of 2009.”^3,4 While the HIT process has received much attention in the popular press, little mention has been made about its purpose, which includes “improving healthcare quality; reducing medical errors; reducing health disparities; advancing the delivery of patient-centered medical care; and reducing healthcare costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information.”³ Similarly, the increased funding for basic NIH research has been discussed much more frequently than the $400 million in the NIH funding allocated for the Agency for Healthcare Research and Quality (AHRQ) to conduct healthcare comparative effectiveness research.⁴

     The fact that these initiatives, now signed into law, are actually based on recommendations made by health policy experts is encouraging. For example, the first two Institute of Medicine recommendations for improving healthcare in the United States involve 1) applying evidence to healthcare delivery and 2) using information technology.² Concerns about HIT security are real — and extensively reviewed in H.R.1³ — but it is interesting to note that the insurance industry has been using this technology for years. Also known as utilization review, pre-certification, concurrent review, discharge planning, and other euphemisms, this technology has used patient information and computer-based systems, including programs such as the Milliman Care Guidelines® to determine medical necessity. Furthermore, the fine print in most health insurance documents reads something to the effect: “When necessary or appropriate for your care or treatment, the operation of our health plans, or other related activities, we use personal information internally, share it with our affiliates, and disclose it to healthcare providers, payors, other insurers, third-party administrators, vendors, consultants, government authorities and their respective agents.”⁵ In response to worries about physician autonomy and government interference as a result of the HIT legislation, a physician⁶ wrote, “Right now, my patients’ insurance programs do exactly the same thing—if I prescribe an angiotensin receptor blocker for blood pressure control, I’m going to be asked to justify why I am giving this rather than the cheaper and as-effective ACE-inhibitor.”

     The challenges of the infamous US economic stimulus bill are just beginning and should not be underestimated. But for all of us dedicated to the science of healthcare, it is encouraging to note the following observation of the American Association for the Advancement of Science⁴: “The stimulus bill represents a welcome acknowledgment from policymakers that scientific research, often regarded as long-term and future-oriented, also has a role to play in short-term economic recovery, and also represents a dramatic turnaround from the flat or declining research funding trends of recent years.”

     Thus, there has been no better time for OWM readers to learn more about health technology (including telemedicine) and to conduct long-awaited, much-needed controlled wound prevention and treatment clinical studies (and submit them for publication). May the stimulus not only shore up a flailing economy, but also provide the beginning of the end of tradition-based prevention and care.

This article was not subject to the Ostomy Wound Management peer-review process.

1. Mouës CM, Heule F, Legerstee R, Hovius SER. Five millennia of wound care products — what is new? A literature review. Ostomy Wound Manage. 2009;55(3):16–32.

2. Institute of Medicine. Crossing the Quality Chasm: A new Health System for the 21st century. Available at : www.iom.edu/CMS/8089/5432/27184.aspx. Accessed on January 26, 2009.

3. One Hundred, Eleventh Congress of the United States. American Recovery and Reinvestment Act of 2009 (H.R.1). Available at: www.whitehouse.gov/the_press_office/arra_public_review. Accessed on February 18, 2009.

4. The American Association for the Advancement of Science. Final Stimulus Bill Provides $21.5 Billion for Federal R&D. Available at: www.aaas.org/spp/rd/stim09c.htm. Accessed on February 22, 2009.

5. Aetna. Important Disclosure Information (2006). Available at: www.aetna.com/data/disclosures/generic_disclosure.pdf. Accessed on February 22, 2009.

6. Lipson P. Health care and the Stimulus Plan. Science Based Medicine. Available at: www.sciencebasedmedicine.org/?p=379. Accessed February 22, 2009.