The Current State of Evidence-Based Protocols in Wound Care

Diversified Clinical Services, Jacksonville, FL 32216, USA.
Plastic and Reconstructive Surgery (Impact Factor: 2.99). 01/2011; 127 Suppl 1(1):144S-153S. DOI: 10.1097/PRS.0b013e31820023dc
Source: PubMed


Clinical practice guidelines have blossomed in the last 10 years in medicine as well as wound care. The physician practicing wound care and attempting to use published clinical practice guidelines may, however, have difficulty judging the quality of these guidelines given legitimate concerns that many aspects of clinical practice guidelines are not being properly addressed.
Guidelines were located using the National Guideline Clearinghouse Web site, PubMed, and the Cochrane database for reviews on diabetic foot ulcers, venous ulcers, and pressure ulcers. The Appraisal of Guidelines for Research and Evaluation instrument was used to evaluate guidelines.
Search engines returned many irrelevant guidelines. Many guidelines would be difficult to evaluate by clinicians not versed in guideline evaluation and were cumbersome in format or were presented more as reference works. Too little attention is focused on such issues as clarity of presentation, consideration of multidisciplinary panels, stakeholder involvement, validity, testing, settings, resources required, cost impact, methods of addressing guideline implementation, and a means of tracking important criteria for feedback once the guideline is in the field. The venous and diabetic ulcer guidelines that were formally evaluated scored poorly in many of these areas despite using relatively sound methods for gathering and evaluating the evidence. Only the developers of one guideline made a commitment for regular update.
Although progress has been made in regard to wound care clinical practice guidelines, much more work will be required before such guidelines are highly accepted by wound care clinicians.

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    • "short horizon times, questionable model inputs, or incomplete or poorly structured models), in the field of wound care such studies are mostly concerned with basic wound care and advanced therapies rather than examining the costs and benefits of applying a broader strategic treatment pattern. Consequently, little thought seems to have been given to the implementation and actual testing of CPGs in practice, particularly from a cost-effectiveness point of view [13]. Because examination of CPGs and strategies to improve cost effectiveness in wound care has been poorly explored, this is the subject of this systematic review. "
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    ABSTRACT: Costs of chronic wound care are significant, but systematic reviews of cost-effectiveness studies regarding guideline-based or strategic interventions are scarce. Our objectives were to assess/compare the cost effectiveness of new interventions/systems designed to improve the prevention/treatment of chronic wounds in adult populations against current care and provide decision makers with information on which to base future interventions for chronic wound management. Data sources included PubMed, Scopus, HTA, and NHS EED. We included comparative health economic evaluations of interventions published in English designed to prevent or treat adult chronic wounds that were guideline-based or strategic in nature and from which an incremental cost-effectiveness ratio or incremental net health benefit was reported or could be calculated. Study and model characteristics and outcomes were extracted into pre-designed tables. Quality assessment of studies was based on literature-reported methods. Studies were assigned strength of evidence ratings and recommendation level for decision makers. A total of 16 health economic evaluations were included, of which ten were trial based and six were wholly model based. Only three studies had high, and five studies moderate, strength of evidence and were recommended for decision makers. All studies had some shortcomings regarding time horizon, costs, effectiveness units, and methodological reporting. Two studies had major flaws. Limitations include missed studies published in non-English languages or not cited in searched databases; judgment bias in assessing studies. Few well conducted cost-effectiveness studies exist to guide decision makers regarding guideline-based or strategic interventions for chronic wounds.
    Applied Health Economics and Health Policy 03/2014; 12(4). DOI:10.1007/s40258-014-0094-9
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    Plastic and Reconstructive Surgery 01/2011; 127 Suppl 1(1):7S-9S. DOI:10.1097/PRS.0b013e3182027d31 · 2.99 Impact Factor
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    ABSTRACT: Chronic ulcers are a growing cause of patient morbidity and contribute significantly to the cost of health care in the United States. The most common etiologies of chronic ulcers include venous leg ulcers (VLUs), pressure ulcers (PrUs), diabetic neuropathic foot ulcers (DFUs), and leg ulcers of arterial insufficiency. Chronic wounds account for an estimated $6 to $15 billion annually in US health care costs; however, it is difficult to get accurate measurements on this, because these patients are often seen in a variety of settings or simply fail to access the health care system.
    Dermatologic clinics 01/2012; 30(1):107-11, ix. DOI:10.1016/j.det.2011.08.005 · 1.69 Impact Factor
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