Development of a Content-Validated Venous Ulcer Guideline

  • Wed, 9/3/08 - 10:25am
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Author(s): 
Laura Bolton, PhD, Adj. Assoc. Prof, FAPWCA; Lisa Corbett, APRN, BC, CWOCN; D. Laurie Bernato, RN, MN; Peggy Dotson, RN, BSN; Scott Laraus, PT, CWS; Diane Merkle, APRN, CWOCN; Gregory Patterson, MD, FACS, CWS; Tania Phillips, MD, FAAD; Patrick McNees, PhD; Peggy Porter Riedesel, PT, CWS; Peter Sheehan, MD; and the AAWC Government and Regulatory Task Force

Venous ulcers (VU) profoundly decrease a person’s quality of life.1,2 They affect up to 1% of the population over 60 years of age at any given time3,4 and cost an estimated $2.5 to $3.5 billion US healthcare dollars annually.5 A MEDLINE literature search revealed that VU patients currently experience an evidence-reimbursement gap for compression modalities and patient education essential for effective, cost-effective VU healing outcomes.6 To lay the foundation for closing this gap, the Association for the Advancement of Wound Care (AAWC) Government and Regulatory Task Force (henceforth abbreviated “the Task Force”) resolved to develop a content-validated VU guideline based on objective summaries of best available evidence supporting each step of VU care.

Methods

The multidisciplinary, all-volunteer Task Force including 11 Advanced Practice Nurses or Wound Ostomy Continence Nurses (WOCNs), five physicians, four physical therapists, two PhDs, one Doctor of Podiatric Medicine, and a Registered Pharmacist first met on April 29, 2002, at the Symposium for Advanced Wound Care in Baltimore, Md. The Task Force adopted the mission of helping US government and regulatory authorities close gaps between wound care evidence and practice. The Task Force used Total Quality Leadership7 tools including brainstorming and fishbone diagrams to identify regulatory and reimbursement issues preventing professionals from practicing quality evidence-based VU care. They developed and prioritized strategies for resolving these issues to help close the gap between VU evidence-based care and actual practice.

The Task Force identified eight issues impeding evidence-based, cost-effective VU practice (see Table 1) and resolved to outline the best available evidence supporting each step in VU care. Steps were listed from published algorithms and best evidence supporting each step of care was included to create an evidence-based decision tool for care providers and reimbursement authorities. In addition to including outcome evidence for each step, the Task Force additionally intended to include the reimbursement status of the step to help authorities define and reduce gaps between evidence-based practice and reimbursement policies. However, reimbursement policies are so varied across settings, professions, states, and regions that reimbursement listings proved impractical. In the end, the Task Force focused on generating an inclusive algorithm annotated with the best available research, hoping to set the stage for reimbursing high quality, evidence-based, cost-effective wound care practice in patients with venous disease.

References: 

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