The AAWC Conceptual Framework of Quality Systems for Wound Care

Author(s): 
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



Framework formulation. Over the next 14 months, Task Force members discussed the issues affecting quality within their varied work environments. Using the information gleaned from the literature and Task Force members’ expertise, several components were unanimously agreed to be crucial to a successful wound care program: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equitableness were recognized for their applicability regardless of patient diagnosis, site of service, and regulatory or pay source.

During review of the literature search, the Institute of Medicine framework article1 was presented and discussed. Two Task Force members developed a diagrammatic representation of quality as a building, with each portion of the building representing a different factor affecting quality. For example, the foundation is the patient and caregiver and their relationship and responsibilities to each other and the roof represents the regulatory and accreditation agencies and their responsibilities to the health delivery system and, ultimately, the patient.

Document review and acceptance. The work of writing the paper was divided among the Task Force subcommittees, with each section reviewed, critiqued, and re-written by the entire committee. Each section was reviewed for clarity, consistency with the other sections and with the goal of the paper, and reputable sources and citations supporting the assertions and was re-written until the full committee was in agreement with the results.

Discussion/Conclusion

When the AAWC Conceptual Framework of Quality Systems for Wound Care was completed, the Quality of Care Task Force had three goals: distribute it as widely as possible (publication in an indexed journal and on the AAWC website), stimulate discussion about intentionally creating and reinforcing quality care, and create a “baseline” document to serve as a foundation for others to use in their pursuit of quality care provision. During the 4 years the Quality of Care Task Force spent developing this framework, each of its versions has made it more applicable, flexible, and responsive to the variety of factors that affect quality. Future research is needed to create a body of literature addressing the process of quality wound care, rather than focusing only on outcomes.

AAWC Conceptual Framework of Quality Systems for Wound Care

The AAWC Conceptual Framework of Quality Systems for Wound Care describes an innovative conceptual model that serves as a basis for meeting the AAWC strategies to facilitate high quality wound care for patients and clients across the continuum of care. The framework also provides guidance and support to the systems that offer wound care services.

The framework uses the Institute of Medicine’s (IOM) Crossing the Quality Chasm: A New Health System for the 21st Century1 as an inspiration for defining quality systems for wound care (see Figure 1). Each segment is responsible to the others. The loss of any segment jeopardizes the integrity of the entire structure.

At the foundation of the framework is the patient/client. The concept of placing the patient at the base of the conceptual model facilitates patient empowerment and ownership in the decision-making processes related to wound management. The incorporation of the concept of the patient as the foundation of the pillars of quality requires that the patient have:

  • Collaborative relationships with healthcare providers who share knowledge and cooperatively set treatment goals

References: 

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.



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