Ferreras Daniel T, Craig Sean, Malcomb Rebecca
Surgical Services, Carl Vinson VA Medical Center, Dublin, Georgia.
Alexandria VA Health Care System, Pineville, Louisiana.
Surg Technol Int. 2017 Jul 25;30:61-69.
A novel, comprehensive decision-making and treatment algorithm was established within a US government-run military veteran hospital in an attempt to standardize the process of outpatient wound care and streamline costs. All patients were systematically evaluated and treated using the comprehensive algorithm over a span of nine months. After three months of adherence to the algorithm, the algorithm was modified to include ovine-based collagen extracellular matrix (CECM) dressings as a first-line conventional treatment strategy for all appropriate wounds. The purpose of this retrospective analysis was to evaluate the hospital's change in cellular and/or tissue-based graft usage and cost, as well as wound healing outcomes following modification of the wound care standardization algorithm. Data from the first quarter (Q1; three months) of protocol implementation were compared to the subsequent two quarters (six months), during which time the first-line dressing modification of the protocol was implemented. Results showed that between quarters 1 and 3, the percentage of wounds healed increased by 95.5% (24/64 to 80/109), and the average time to heal each wound decreased by 22.6% (78.8 days to 61.0 days). Cellular and/or tissue-based graft unit usage decreased by 59.7% (144 units to 58 units), and expenditures on cellular and/or tissue-based grafts decreased by 66.0% ($212,893 to $72,412). Results of this analysis displayed a trend toward decreased expenditures, faster healing times, and a greater number of healed wounds following modification of an evidence-based algorithm to incorporate CECM dressings as a first-line treatment strategy in managing chronic wounds.
在美国一家政府运营的退伍军人医院内,建立了一种新颖、全面的决策与治疗算法,旨在规范门诊伤口护理流程并简化成本。在九个月的时间里,所有患者均使用该综合算法进行系统评估和治疗。在遵循该算法三个月后,算法进行了修改,将基于羊胶原蛋白的细胞外基质(CECM)敷料纳入所有合适伤口的一线常规治疗策略。这项回顾性分析的目的是评估医院在细胞和/或组织基移植物使用及成本方面的变化,以及伤口护理标准化算法修改后的伤口愈合结果。将方案实施第一季度(Q1;三个月)的数据与随后两个季度(六个月)的数据进行比较,在这期间实施了方案的一线敷料修改。结果显示,在第1季度和第3季度之间,伤口愈合的百分比增加了95.5%(从24/64增至80/109),每个伤口的平均愈合时间减少了22.6%(从78.8天降至61.0天)。细胞和/或组织基移植物的使用量减少了59.7%(从144单位降至58单位),细胞和/或组织基移植物的支出减少了66.0%(从212,893美元降至72,412美元)。该分析结果显示出一种趋势,即在将基于证据的算法修改为纳入CECM敷料作为管理慢性伤口的一线治疗策略后,支出减少、愈合时间加快且愈合伤口数量增加。