Quality of Care in Chronic Leg Ulcer in the Community: Introduction of Quality Indicators and a Scoring System

Abstract

Background: Treatment of chronic wounds is complex, particularly as a standard for the assessment and evaluation of quality of care is missing. Objectives: To develop indicators for quality of care in chronic wounds in general, and to evaluate the quality of care in leg ulcers in Hamburg, Germany, in particular. Methods: Twenty indicators were derived from a national Delphi expert consensus to compute a single index of quality of care. This index was applied in a cross-sectional study involving a large spectrum of care providers and leg ulcer patients in the community. Trained wound experts interviewed and examined the patients, who had to complete standardized questionnaires. Results: On average, 64% of the quality criteria were met in the consecutive sample of 502 patients with chronic leg ulcers of any origin; 75% of the patients were satisfied with their wound care. Predictors of quality of care are presented. Conclusions: This instrument is feasible, valid and ready for comparisons of patient groups, regions and care systems, and for optimization processes in wound care.

Power through standards: The Federal Conference for Outcome Measurement and Benefit Assessment of Chronic Wounds

“…Until now, therefore, the wound sector has missed a major opportunity to acquire relevant evidence by using comparable outcome data in both routine clinical care and in clinical and health care research. Due to the high burden of costs imposed by chronic wounds in Germany (9, 10), the specific burden for both patients and their relatives (11,12) and the recognisable deficits in the provision of care (13)(14)(15), unification of outcome measurements and their evaluation will assume great significance in future if there is to be a sustained improvement in the quality of care.…”

Patient-reported outcomes as diagnostic tools and clues in chronic wounds: Considerations for practice

“…Along the course of treatment, the patient-reported outcomes need to be reevaluated and any additional burden developing from the treatment itself needs to be identified. Thus, patient-reported information is needed throughout the treatment period for any wound and the measurement of PRO is a quality marker of wound health care [3].…”

“…In wound treatment, PROs like quality of life are recommended by the European Wound Management Association (EWMA) consensus [5] and numerous outcomes tools have been developed [6][7][8][9]. Moreover, several assessments of PROs are included in the indicator sets for evaluating quality of health care [3] (Table 1).…”

“…Additionally, it may prove useful to investigate the single predictors of QoL in chronic skin diseases [8]. For example, it has Table 1 Inclusion of PROs (marked bold) in the set of German quality indicators of guideline-compliant wound treatment practice in leg ulcers (German Delphi Panel, 2011 [3]). These 20 items indicate essential procedures for all or for specified (marked with an asterisk *) subgroups of wounds.…”

Loss of Interface Pressure in Various Compression Bandage Systems over Seven Days

“…Persons with leg ulcers have a reduced quality of life. These patients report wound odor, moistness, sleeping disorders, itching, swollen legs, pain, limited mobility and additionally psychic consequences up to the point of social isolation [3,4,5]. Continuous compression therapy is the main treatment of venous leg ulcer.…”