The Association Between Risk-Adjusted Wound Healing Rates and Long-Term Outcomes in a Network of U.S. Wound Care Clinics.

Abstract

Objective: Chronic wounds have a high prevalence and poor outcomes in a geriatric population. It is unknown whether higher rates of successful wound healing are associated with better long-term outcomes. We sought to determine the association of risk-adjusted healing rates in wound care clinics with postdischarge outcomes. Approach: This observational study compared outcomes of Medicare patients with chronic wounds who received care at clinics with the highest risk-adjusted wound healing rates (n = 91) to those with the lowest rates (n = 88) in a network of 510 specialized U.S. wound care clinics. All 12,703 patients with chronic wounds at the clinics that could be identified in Medicare data were included. The outcomes were incidences of wound recurrence, gangrene, sepsis, and amputation after discharge. Results: The study included 6,462 and 6,241 patients in top- and bottom-performing clinics, respectively. Being treated in a top-performing clinic was associated with a lower cumulative incidence of all four outcomes. The difference was statistically significantly lower for wound recurrence (adjusted hazard ratio [aHR] = 0.82, 95% confidence interval [CI] 0.76-0.87, p < 0.001) and gangrene (aHR = 0.62, 95% CI 0.52-0.76, p < 0.001) but not for sepsis (aHR = 0.88, 95% CI 0.76-1.001, p = 0.065) and amputation (aHR = 0.75, 95% CI 0.65-1.00, p = 0.055). Innovation: This study is the first to suggest that patients treated in clinics with better wound-healing outcomes also have better outcomes after discharge. This finding can inform analyses to understand differences in practice patterns that lead to better outcomes. Conclusion: Treatment of chronic wounds in wound care clinics with higher risk-adjusted healing rates is associated with a lower risk of wound-related adverse events during follow-up, particularly in the first year. More research is needed to understand the factors that contribute to this effect and to determine interventions to improve outcomes sustainably as well as assess the impact of changes in outcomes on resource utilization and patients' quality of life.