Evidence-based chronic ulcer care and lower limb outcomes among Pacific Northwest veterans.

Karavan M, Olerud J, Bouldin E, Taylor L, Reiber GE. Evidence-based chronic ulcer care and lower limb outcomes among Pacific Northwest veterans. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society. 2015 Sep 17; 23(5):745-52.

Related HSR&D Project(s)

• IBA 09-061 – Access to Care for Veterans with Chronic Lower Limb Wounds

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Abstract:

Evidence-based ulcer care guidelines detail optimal components of care for treatment of ulcers of different etiologies. We investigated the impact of providing specific evidence-based ulcer treatment components on healing outcomes for lower limb ulcers (LLU) among veterans in the Pacific Northwest. Components of evidence-based ulcer care for venous, arterial, diabetic foot ulcers/neuropathic ulcers were abstracted from medical records. The outcome was ulcer healing. Our analysis assessed the relationship between evidence-based ulcer care by etiology, components of care provided, and healing, while accounting for veteran characteristics. A minority of veterans in all three ulcer-etiology groups received the recommended components of evidence-based care in at least 80% of visits. The likelihood of healing improved when assessment for edema and infection were performed on at least 80% of visits (hazard ratio [HR]? = 3.20, p? = 0.009 and HR? = 3.54, p? = 0.006, respectively) in patients with venous ulcers. There was no significant association between frequency of care components provided and healing among patients with arterial ulcers. Among patients with diabetic/neuropathic ulcers, the chance of healing increased 2.5-fold when debridement was performed at 80% of visits (p? = 0.03), and doubled when ischemia was assessed at the first visit (p? = 0.045). Veterans in the Pacific Northwest did not uniformly receive evidence-based ulcer care. Not all evidence-based ulcer care components were significantly associated with healing. At a minimum, clinicians need to address components of ulcer care associated with improved ulcer healing.