Guideline Concordant Care Improves Outcomes for Veterans with Venous Ulcers
Venous ulcers are a common, debilitating condition that account for up to 80% of all leg ulcers. In FY07, there were more than 35,000 Veterans receiving care for venous ulcers in the VA healthcare system. A widely endorsed set of guidelines was developed by the Wound Healing Society for treatment of venous ulcers, but there is little data examining real-world guideline concordant care and its impact on healing. This retrospective cohort study evaluated the association between the delivery of guideline concordant venous ulcer care and outcomes, including time to healing. Using VA data, investigators identified 155 Veterans with 400 venous ulcers who were treated in the VA Puget Sound Healthcare system between 10/03 and 9/07. Using the 2006 Wound Healing Society guidelines for venous ulcers, guideline-concordant care was defined as adherence during at least 80% of patient visits with the use of: dressings creating a moist wound-healing environment, use of a multi-layer compression device (excluding monolayer devices like ace wraps and compression stockings), and ulcer debridement.
Findings show that guideline concordant venous ulcer care was significantly associated with venous ulcer healing, when provided at 80% or more of patient visits. The likelihood of ulcer healing increased when compression therapy or a moist wound-healing environment were provided during at least 80% of the visits; debridement alone was not significantly associated with ulcer healing. Veterans who received all three treatments during at least 80% of their visits were more likely to heal than those who received less than 80%. For this cohort of Veterans, a majority of ulcers healed (n=362), with an average time to healing of 18.1 weeks, which is much better than the reported average of 36 weeks. These results show the importance of providing guideline concordant venous ulcer care for Veterans and other elderly males (generalization of these findings to other populations, including women, requires caution).
Olson J, Raugi G, Nguyen V, Yu O, and Reiber G. Guideline concordant venous ulcer care predicts healing in a tertiary care Veterans Affairs Medical Center. Wound Repair and Regeneration September-October 2009;17(5):666-70.
This study was funded by HSR&D and VA's Rehabilitation Research & Development Service. Drs. Olson, Raugi, and Reiber are part of HSR&D's Northwest Center for Outcomes Research in Older Adults in Seattle. Dr. Reiber also is part of VA/HSR&D's Diabetes Mellitus Quality Enhancement Research Initiative (DM-QUERI).