Publicly Reported Wound Healing Rates: The Fantasy and the Reality

Abstract

Significance: 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).Recent Advances: 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.Critical Issues: 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.Future Directions: 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.

An open‐label trial of cryopreserved human umbilical cord in the treatment of complex diabetic foot ulcers complicated by osteomyelitis

“…The results of this multicenter, open‐label, pilot study suggest that TTAX01 is a promising therapy for the management of complex, nonhealing DFUs complicated by osteomyelitis. Following TTAX01 treatment, the overall healing rate was favorable compared to the US Wound Registry standard of care success rates, which reported 31% healing of all DFUs at 12 weeks and 45% healing regardless of time period . SOC treatment success is reported to be even lower for complex wounds, with only 33% achieving complete wound closure at 20 weeks .…”

“…Following TTAX01 treatment, the overall healing rate was favorable compared to the US Wound Registry standard of care success rates, which reported 31% healing of all DFUs at 12 weeks and 45% healing regardless of time period. 9 SOC treatment success is reported to be even lower for complex wounds, with only 33% achieving complete wound closure at 20 weeks. 10 As a further point of reference, the chronic wounds database from Healogics Inc. was accessed to examine healing rates in patients matched against the inclusion criteria for this study.…”

“…The current standard of care (SOC) regimen for complex DFU involves surgical debridement of necrotic tissue and bone, prevention or control of infection with antibiotics, and offloading. However, the rate of wound healing with the current SOC is poor, with only 30% of DFUs healing within 12 weeks and 45% healing regardless of the time period . This healing rate is even lower for complex wounds, with 33% achieving complete wound closure at 20 weeks .…”

“…However, the rate of wound healing with the current SOC is poor, with only 30% of DFUs healing within 12 weeks and 45% healing regardless of the time period. 9 This healing rate is even lower for complex wounds, with 33% achieving complete wound closure at 20 weeks. 10 The nonhealing nature of these chronic wounds has led to the development of advanced cellular and tissue-based products and therapeutic biologics to move these wounds from a chronic, stalled condition to a trajectory of healing.…”

ReGeneraTing Agents (RGTA®): A new option for healing and improving treatment outcomes for traumatic and burn injuries of the hand

“…After initial daily dressings for 6 days, which he found excruciatingly painful, skin grafting was performed at his request. Unfortunately, after 10 days the graft did not take and sloughed off leaving a 33 × 25 mm sized wound (Figure B), which would have taken at least 4 weeks to heal . It was decided to start CACIPLIQ20 ® the next day because his pain tolerance was low (VAS—visual analog score—of 7) and conventional treatments had failed.…”