The AAWC Conceptual Framework of Quality Systems for Wound Care

Timothy G. Paine, PT, CWS, FCCWS; Catherine T. Milne, APRN, MSN, CWOCN; Jane Ellen Barr, RN, MSN, ANP, CWOCN; Renee Cordrey, PT, PhD(c), MSPT, MPH, CWS; Susan E. Dieter, RN, MS, CWCN, CWS; Judith Harwood, BS, RN, CWOCN; R. Allen Sawyer, PT, CWS; Kimberly Trepanier, PT, CWS; and Stephanie Woelfel, PT, MPT, CWS, FCCWS

In 2002, the Association for Advanced Wound Care (AAWC) formed and funded the multidisciplinary Quality of Care Task Force with the intent to improve the quality of wound care services. This task force, represented by podiatrists (DPMs), registered nurses (RNs), advanced practice registered nurses (APRNs), wound ostomy continence nurses (WOCNs), and physical therapists (PTs) who are consultants, clinicians, administrators, and manufacturers working in hospital-based, outpatient, freestanding, and home health service arenas is a diverse multidisciplinary group with insights into the full breadth of the healthcare system.

After determining that no single universally accepted definition of quality existed as related to wound care, the Task Force moved to identify components of quality wound care that are applicable across disciplines, service sites, and the continuum of care. A framework of wound care quality indicators for practice was created; it was suggested this framework then could be used to create or critique a wound care service delivery system. The framework was designed to be responsive to the needs of not only the clinician, but also the managers and regulatory agencies that oversee care. The Task Force consensus paper provides the framework for a wound care delivery system that is grounded in quality, flexibility, and effectiveness while recognizing and being responsive to regulatory and managerial guidelines.


Literature search. From May 2002 to May 2004, the Task Force performed a wound care literature search on the topic of “quality” and its subsets of “wound,” “ulcer,” “healing,” “health,” “clinical,” “hospital,” and “skin” and further subsets such as “arterial,” “venous,” “diabetic,” “vascular,” “neuropathic,” and “chronic” using sources such as the Cochrane Collaborative Databases and Reviews, National Institutes of Health, the Institutes of Medicine websites, and links from relevant national associations including the American Academy of Wound Management; the Wound, Ostomy, Continence Nursing Society; the American Medical Association; the National Pressure Ulcer Advisory Panel; the American Physical Therapy Association; the American Academy of Dermatology; and the American Podiatric Medical Association. Additionally, insurer websites such as the Center for Medicare and Medicaid Services, United Healthcare, and regional Blue Cross and Blue Shield members were searched for quality indicators or assessment tools. Articles were found that equated quality with outcomes and end points, but no articles were found that incorporated the full breadth of the relationships between the clinical providers, the institutional management system, and the regulatory organizations and their systems. When no citations were found, the Task Force expanded the search into the medical and business literature using websites from the Small Business Administration, The British Quality Foundation, and the US Chamber of Commerce; fewer than five articles were tangentially relevant. The list of articles from these searches were culled to include only those relevant to wound care or its delivery systems.


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