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How does quality wound care drive value-based care?

April 19, 2017 by Amber Fowler, MSN, RNC, CWOCN, Clinical Program Director

value-based careThis May, I will have been a nurse for 25 years, and 20 of those years have been spent in wound care. Much has changed in those 20 years, Baby Boomers are aging, chronic disease rates are rising, and patients suffering from chronic wounds are costing our healthcare system an estimated $50 billion annually. And yet, despite the clinical complexity of wound care treatment and the number of patients in need (who may not even know it!), the average provider-in-training receives under 10 hours of formal education related to wound care. Wounds are not considered a condition like cancer or heart disease, which means that there is no disease category or recognized specialty, and no standardized way to diagnose or treat chronic wounds. I bet you didn’t know that patients whose non-healing wounds result in amputation may have a mortality rate of up to 50 percent in five years – a rate similar to several types of cancer.
There is a light at the end of the tunnel in the form of value-based care. Anchored on both quality outcomes and affordable access to care, patient-centered value based care will require a complete transformation of our healthcare system, and at the core of this transformation is communications and care coordination. So where does wound care fit in all of this, and how can we broaden awareness of and expand patient access to quality, evidence-based wound care?
The current state of wound care in the United States is an unfortunate victim of our traditional, broken fee-for-service healthcare system, a system that promotes fragmentation and lack of communication. As wound care providers, we can do our part to accelerate and promote value-based care by sharing best practices and evidence based data, educating our community on the real causes of chronic wounds and when specialty wound care might be needed. More than most any other segment in the healthcare system, wound care depends on providers communicating to providers, nurses coordinating with nurses and providers engaging with nurses. Without the cooperation and collaboration of all care providers, true healing will never be possible. In addition, we have to be willing to have conversations across specialties and outside our four walls.
We in the wound care sector can be care coordination pioneers and create communication pathways between ourselves and fellow specialists – in fact it’s imperative. Collaboration and communication with our primary care providers, physical therapists, podiatrists, vascular surgeons and in-home health providers will help us provide enhanced, individualized care, and drive awareness with the broader medical community. But let’s not forget about the patient. Communication and care coordination can help patients and their caregivers make informed healthcare decisions, and allow their voices to be heard during the assessment of options.
I have spent time in home care, hospice/end of life care, hospitals and nursing homes. This experience has given me an invaluable perspective, and helped me engage in more meaningful, actionable conversations with my colleagues outside of wound care. Listening to, and understanding, their and our patient’s challenges is the first step towards effective collaboration.
I also have another powerful tool on my side: our local Care Coalition. The Care Coalition includes providers in long term care, home health, rehabilitation and others. Our goal is to provide a collaborative vehicle that opens lines of communication and allows us to discuss common patient care challenges and potential solutions. Specific challenges have included transportation, health literacy and prescription adherence. We meet once a month, which is only a couple of hours out of my schedule – and it’s worth it. Our local Care Coalition has actually helped me find a solution to one of the largest issues impacting our ability to deliver quality wound care to our patients – transportation.
I challenge us, as wound care providers, to participate in our local Care Coalitions, and if one doesn’t exist – build it! Be bold, ask the hard questions and find the solutions. Make communications, collaboration and care coordination a clinical and community priority towards the best possible outcomes for our patients now and in the future.