Publicly Reported Wound Healing Rates: The Fantasy and the Reality.

Caroline E Fife,Marissa J Carter,Kristen A Eckert

doi:10.1089/wound.2017.0743

Caroline E Fife, Marissa J Carter + Show 1 more

Open Access

https://doi.org/10.1089/wound.2017.0743

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Abstract

Significance: We compare real-world data from the U.S. Wound Registry (USWR) with randomized controlled trials and publicly reported wound outcomes and develop criteria for honest reporting of wound outcomes, a requirement of the new Quality Payment Program (QPP).Recent Advances: Because no method has existed by which wounds could be stratified according to their likelihood of healing among real-world patients, practitioners have reported fantastically high healing rates. The USWR has developed several risk-stratified wound healing quality measures for diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs) as part of its Qualified Clinical Data Registry (QCDR). This allows practitioners to report DFU and VLU healing rates in comparison to the likelihood of whether the wound would have healed.Critical Issues: Under the new QPP, practitioners must report at least one practice-relevant outcome measure, and it must be risk adjusted so that clinicians caring for the sickest patients do not appear to have worse outcomes than their peers. The Wound Healing Index is a validated risk-stratification method that can predict whether a DFU or VLU will heal, leveling the playing field for outcome reporting and removing the need to artificially inflate healing rates. Wound care practitioners can report the USWR DFU and VLU risk-stratified outcome measure to satisfy the quality reporting requirements of the QPP.Future Directions: Per the requirements of the QPP, the USWR will begin publicly reporting of risk-stratified healing rates once quality measure data have met the reporting standards of the Centers for Medicare and Medicaid Services. Some basic rules for data censoring are proposed for public reporting of healing rates, and others are needed, which should be decided by consensus among the wound care community.

Highlights

requirement of CMS under the new Qual- Wound outcomes must be reported under the new Quality Payment ity Payment Program
providers and consumers should be cautioned that the internet is currently a maddening Wonderland
social media accessed by consumers

Summary

DISCUSSION

When it comes to outcome data, both providers and consumers should be cautioned that the internet is currently a maddening Wonderland. Wound outcome data absolutely must consider the site and setting of care, the wound management and standard of care undertaken, the point at which providers are involved in the continuum of care, and risk stratification of patients and wound complexity and severity to report honest rates.[106]. More transparent and honest wound healing outcome data will follow after the quality of care is measured based on the percentage of healed patients when risk stratification is used to determine their healing likelihood.[115] By using risk stratification, we could identify which practitioners or institutions may be providing exemplary care, not by reporting healing rates over 90%, but by a healing rate of, for example, 50% among wounds with only a 30% predicted likelihood of healing.

Conclusions

SUMMARY