The AAWC Conceptual Framework of Quality Systems for Wound Care
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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.
1. Committee on Quality Healthcare in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
2. Association for Advancement of Wound Care. Wound Care Patient Bill of Rights. Malvern, Pa: Association for Advancement of Wound Care;1995.
3. Committee on Quality Healthcare in America, Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press;1999.
4. National Patient Safety Foundation. National Agenda for Action: Patients and Families in Patient Safety: Nothing about Me, Without Me. North Adams, Mass: National Patient Safety Foundation; 2002. Available at http://www.npsf.org/download/2002annualreport. Accessed February 3, 2006.
5. Han P, Ezquerro E. Diabetic foot wound care algorithms. J Am Podiatr Med Assoc. 2002;92(6):336–349.
6. Agency for Healthcare Research and Quality. National Guideline Clearing House. Available at: http://www.guidelines.gov. Accessed June 1, 2006.
7. American Medical Director Association. Clinical practice guidelines. Available at: http://www.amda.com/tools/guidelines.cfm. Accessed January 8, 2006.
8. Association for Advancement of Wound Care. Government and Regulatory Task Force, 2005. Summary algorithm for venous ulcer care with annotations of available evidence. Available at http://www.guidelines.gov/summary/summary.aspx?doc_id=7109&nbr=004280&st.... Accessed October 10, 2005.
9. Wound Ostomy Continence Nurses Society, 2005. Guideline for management of wounds in patients with lower-extremity venous disease. Available at http://www.guideline.gov/summary/summary.aspx?doc_id=7485&nbr=4431. Accessed January 15, 2006.
10. Muir Gray JA. Evidence-based Healthcare: How to Make Health Policy and Management Decisions. London, UK: Churchill Livingstone;1997.
11. Graham G. Evidence-based practice. An international perspective. Physio Forum. 2001;15(8):13–14.
12. Geddes J. Evidence-based practice in mental health. In: Trinder L, Reynolds S (eds). Evidenced-based Practice — A Critical Appraisal. Oxford, UK: Blackwell Science;2000.
13. Ramsey SD. Evaluating evidence from a decision analysis. In: Geyman JP, Deyo RA (eds). Evidence-Based Clinical Practice: Concepts and Approaches. Oxford, UK: Butterworth-Heinemann;2000.
14. Bolton L. Outcomes research. WOUNDS. 2004;16(5):148–149.
15. Soon S, Chen S. What are wound care outcomes? WOUNDS. 2004;16(5):150–156.
16. Macario A. The economic assessment of advanced wound care products: from research theory to practice. European Tissue Repair Society Bulletin. Available at: http://www.etrs.org/bulletin8_1/index.html. Accessed August 10, 2005.
17. Hibbard J. Perspective: moving toward a more patient-centered health care delivery system. Health Affairs: The Policy Journal of the Health Sphere. October 7, 2004. Available at: http://content.healthaffairs.org. Accessed August 10, 2005.
18. US Department of Health and Human Services, Agency for Healthcare Research and Quality. National Healthcare Quality Report 2004. Available at: http://www.qualitytools.ahrq.gov/qualityreport. Accessed August 10, 2005.
19. Health Care Quality Glossary. Overview. The Russia-United States of America Joint Commission on Economic and Technological Cooperation, The Health Committee, Access to Quality Health Care. Agency for Health Care Policy and Research, Rockville, Md. 1999:26. Available at http://www.ahrq.gov/qual/hcqgloss.htm. Accessed March 14, 2005.
20. Nelson EA, Bradley MD. Dressings and topical agents for arterial leg ulcers. Cochrane Database. 2003;1:CD001836.
21. Moore ZEH, Cowman S. Wound cleansing for pressure ulcers. Cochrane Database. 2005;4:CD004983.
22. Bergin SM, Wraight P. Silver-based wound dressings and topical agents for treating diabetic foot ulcers. Cochrane Database. 2006;1:CD005082
23. Institute for Healthcare Improvement. Leadership guide to patient safety. Available at http://www.ihi.org/IHI/Results/WhitePapers/LeadershipGuidetoPatientSafet.... Accessed August 14, 2006.
24. Beitz JM. Overcoming barriers to quality wound care: a systems perspective. Ostomy Wound Manage. 2001;47(3):56–64.