Fife Caroline E, Eckert Kristen A, Carter Marissa J
Department of Geriatrics, Baylor College of Medicine, Houston, Texas.
The U.S. Wound Registry, The Woodlands, Texas.
Adv Wound Care (New Rochelle). 2018 Mar 1;7(3):77-94. doi: 10.1089/wound.2017.0743.
We compare real-world data from the U.S. Wound Registry (USWR) with randomized controlled trials and publicly reported wound outcomes and develop criteria for honest reporting of wound outcomes, a requirement of the new Quality Payment Program (QPP). Because no method has existed by which wounds could be stratified according to their likelihood of healing among real-world patients, practitioners have reported fantastically high healing rates. The USWR has developed several risk-stratified wound healing quality measures for diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs) as part of its Qualified Clinical Data Registry (QCDR). This allows practitioners to report DFU and VLU healing rates in comparison to the likelihood of whether the wound would have healed. Under the new QPP, practitioners must report at least one practice-relevant outcome measure, and it must be risk adjusted so that clinicians caring for the sickest patients do not appear to have worse outcomes than their peers. The Wound Healing Index is a validated risk-stratification method that can predict whether a DFU or VLU will heal, leveling the playing field for outcome reporting and removing the need to artificially inflate healing rates. Wound care practitioners can report the USWR DFU and VLU risk-stratified outcome measure to satisfy the quality reporting requirements of the QPP. Per the requirements of the QPP, the USWR will begin publicly reporting of risk-stratified healing rates once quality measure data have met the reporting standards of the Centers for Medicare and Medicaid Services. Some basic rules for data censoring are proposed for public reporting of healing rates, and others are needed, which should be decided by consensus among the wound care community.
我们将美国伤口登记处（USWR）的真实世界数据与随机对照试验及公开报告的伤口治疗结果进行比较，并制定伤口治疗结果诚实报告的标准，这是新的质量支付计划（QPP）的一项要求。由于此前不存在一种方法可根据现实世界患者伤口愈合的可能性对伤口进行分层，从业者报告的愈合率高得离谱。作为其合格临床数据登记处（QCDR）的一部分，USWR已针对糖尿病足溃疡（DFU）和下肢静脉溃疡（VLU）制定了几种风险分层的伤口愈合质量指标。这使得从业者能够报告DFU和VLU的愈合率，并与伤口愈合的可能性进行比较。在新的QPP下，从业者必须报告至少一项与实践相关的结果指标，并且该指标必须进行风险调整，以使照顾病情最严重患者的临床医生看起来不会比同行的治疗结果更差。伤口愈合指数是一种经过验证的风险分层方法，可预测DFU或VLU是否会愈合，为结果报告创造公平的竞争环境，并消除人为提高愈合率的必要性。伤口护理从业者可以报告USWR的DFU和VLU风险分层结果指标，以满足QPP的质量报告要求。根据QPP的要求，一旦质量指标数据符合医疗保险和医疗补助服务中心的报告标准，USWR将开始公开报告风险分层的愈合率。我们提出了一些数据审查的基本规则用于愈合率的公开报告，还需要其他规则，这些规则应由伤口护理界达成共识来决定。
