scholarly journals Social, Legal and Economic Implications for the Implementation of an Intelligent Wound Plaster in Outpatient Care

2021 ◽  
Vol 3 ◽  
Author(s):  
Peter Enste ◽  
Alexander Bajwa Kucharski
Keyword(s):  
Outpatient Care ◽  
Chronic Wounds ◽  
Wound Care ◽  
Outpatient Setting ◽  
Data Set ◽  
Economic Implications ◽  
Economic Point ◽  
Outpatient Sector ◽  
Research Questions ◽  
Inpatient And Outpatient Care

Background: The care of chronic wounds is one of the core tasks of inpatient and outpatient care. The correct timing of changes has a significant impact on the positive course of wound healing. The VulnusMON project developed an intelligent wound plaster to determine the optimum time to change the plaster in hospital. Against the background of implementing the solution also in the outpatient sector, this article focuses on the following research questions: What is the legal framework for wound care in outpatient care? What are the differences in wound care between inpatient and outpatient care? What obstacles and barriers arise for the VulnusMON project when it is implemented in the outpatient sector? Can initial economic estimates be made for the transfer to the outpatient sector?Method: Due to the complexity of the different research questions, a mixed method design was used. The qualitative part of the study includes both focus groups and expert interviews. As part of the quantitative analysis, a data set on outpatient wound care was analyzed (n = 463).Results: In summary, it can be stated that the project VulnusMON and its intelligent wound plaster, which aims to determine the ideal time to change a wound plaster is viewed very positively by the professionals. However, there are a number of barriers that inhibit the potential transfer of the new digital solution to the outpatient setting. From an economic point of view, implementation in the outpatient sector makes sense, as travel times can be reduced. However, the study also points out important social implications, that pose several challenges for the actual transfer of the plaster to the outpatient sector.

Example of Wound Care Using Medpar Data

2010 ◽  
pp. 329-345
Author(s):  
Patricia Cerrito ◽  
John Cerrito
Keyword(s):  
Outpatient Care ◽  
Inpatient Treatment ◽  
Wound Care ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Coding Systems ◽  
Total Care ◽  
Treatment Of Wounds ◽  
Inpatient And Outpatient Care ◽  
Detailed Diagnosis

Medpar Data is used for billing Medicare; it typically is “packed” into different sheets of data. The first step required to use the data is to “unpack” it into its component sheets and then to merge the necessary data. Once that is finished, we can examine patients in sequence to investigate the total care of wounds, especially patients who have diabetic foot ulcers. This particular dataset was received from a clinic that specialized in the treatment of wounds. It contains detailed diagnosis information for inpatient and outpatient care. One of the problems is that there are two different coding sets that are used in the Medpar data. Inpatient data are coded using the ICD9 codes; outpatient data are coded using HCPCS codes. The advantage of such a dataset is that the wound care is highly concentrated within it, so that we can focus and drill down into wound care. The disadvantage is that the different coding systems have to be matched for analysis purposes. In this section, we want to look at the type of outpatient care prior to inpatient treatment, and to see if there is a progression of treatment that leads to better patient outcomes.

scholarly journals Joint Consultation Clinic by Infectious Diseases Specialists and Podiatry team (ID-POD) Compliments the Care of Diabetic Patients with Foot Infections by Reducing Cost and Decreasing Outpatient Clinic Visits

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S328-S328
Author(s):  
Pushpalatha Bangalore Lingegowda ◽  
Say-Tat Ooi ◽  
Jyoti Somani ◽  
Chelsea Law ◽  
Boon Kiak Yeo
Keyword(s):  
Infectious Diseases ◽  
Diabetic Foot ◽  
Wound Care ◽  
Cost Savings ◽  
Outpatient Setting ◽  
Multidisciplinary Teams ◽  
Diabetic Patients ◽  
Wound Debridement ◽  
Diabetic Foot Infections ◽  
Before And After

Abstract Background Management of diabetic foot infections (DFI) is challenging and involves multidisciplinary teams to improve outcomes (1). Appropriate wound care of patients with DFI plays an important role in successfully curing infections and promote wound healing. In Singapore, Infectious Diseases (ID) specialists help in the management of DFI by recommending appropriate antibiotics for infected wounds while wound debridement are managed by Podiatrists (POD). When patients are hospitalized multidisciplinary teams including Vascular Surgery review patients. In the outpatient setting patients have multiple appointments including ID and Endocrinology etc. The time spent and costs incurred by patients for traveling to multiple appointments is considerable. A joint ID-POD clinic was initiated to reduce the cost and inconvenience for patients. Methods A joint weekly clinic was initiated in October’16 and the data was analyzed upto May’17. Finance was involved in deriving costs. The service costs for consultations payable by patients before and after the initiation of the joint clinic were compared. Results First 6 months experience of initiating the joint ID-POD clinic is reported. 35 unique patients had a total of 88 visits. 1/third of the patients had more than 2 visits to the joint clinic. For each visit to the joint clinic the patient paid 25% less compared with having separate clinics. The hospital lowered the service cost for the new clinic by 11%. This was done by minimizing the time involvement of the ID physician. Conclusion Joint ID-POD clinic for managing diabetic patients with foot infections revealed several advantages. Hospital outpatient visits for each patient decreased by 50% for those requiring care of both ID and POD, without compromising care. With the consolidation of care each individual patient had a cost savings of 25% for the joint consultation. This joint clinic while making it convenient for patients has revealed significant cost savings to patients especially for those requiring multiple visits. We recommend hospitals with high prevalence of Diabetes and Diabetic foot infections to consider joint ID-POD clinics to reduce hassle and increase saving for patients. Disclosures All authors: No reported disclosures.

Effectiveness of biofilm‐based wound care system on wound healing in chronic wounds

2019 ◽  
Vol 27 (5) ◽  
pp. 540-547 ◽  
Author(s):  
Yukie Mori ◽  
Gojiro Nakagami ◽  
Aya Kitamura ◽  
Takeo Minematsu ◽  
Mikio Kinoshita ◽  
...  
Keyword(s):  
Wound Healing ◽  
Chronic Wounds ◽  
Wound Care ◽  
Care System

Hepatitis C prevalence in HIV-infected individuals: a comparison of inpatient and outpatient care

2014 ◽  
Vol 25 (11) ◽  
pp. 806-811
Author(s):  
Ziqiang Zhu ◽  
Teena Dhir ◽  
Myat Soe ◽  
Linda Green ◽  
Ning Jiang
Keyword(s):  
Hepatitis C ◽  
Outpatient Care ◽  
Inpatient And Outpatient Care

Identifying New Pathways and Targets for Wound Healing and Therapeutics from Natural Sources

2021 ◽  
Vol 18 ◽  
Author(s):  
Xinchi Feng ◽  
Jinsong Hao
Keyword(s):  
Wound Healing ◽  
Molecular Mechanisms ◽  
Chronic Wounds ◽  
Wound Care ◽  
Healing Process ◽  
Unmet Need ◽  
Wound Dressings ◽  
Wound Healing Process ◽  
Natural Sources ◽  
Viable Approach

: Chronic wounds remain a significant public problem and the development of wound treatments has been a research focus for the past few decades. Despite advances in the products derived from endogenous substances involved in a wound healing process (e.g. growth factors, stem cells, and extracellular matrix), effective and safe wound therapeutics are still limited. There is an unmet need to develop new therapeutics. Various new pathways and targets have been identified and could become a molecular target in designing novel wound agents. Importantly, many existing drugs that target these newly identified pathways could be repositioned for wound therapy, which will facilitate fast translation of research findings to clinical applications. This review discusses the newly identified pathways/targets and their potential uses in the development of wound therapeutics. Some herbs and amphibian skins have been traditionally used for wound repairs and their active ingredients have been found to act in these new pathways. Hence, screening these natural products for novel wound therapeutics remains a viable approach. The outcomes of wound care using natural wound therapeutics could be improved if we can better understand their cellular and molecular mechanisms and fabricate them in appropriate formulations, such as using novel wound dressings and nano-engineered materials. Therefore, we also provide an update on the advances in the wound therapeutics from natural sources. Overall, this review offers new insights into novel wound therapeutics.

The Expressiveness of SNOMED CT for Wound Care: Mapping a standardised Item Set for Leg Ulcers to SNOMED CT (Preprint)

2021 ◽  
Author(s):  
Jens Hüsers ◽  
Mareike Przysucha ◽  
Moritz Esdar ◽  
Swen Malte JOHN ◽  
Ursula Hertha Hübner
Keyword(s):  
Health Care Professionals ◽  
Information Exchange ◽  
Chronic Wounds ◽  
Wound Care ◽  
Information Model ◽  
Coverage Rate ◽  
Clinical Usefulness ◽  
Leg Ulcers ◽  
Snomed Ct ◽  
Mapping Procedure

BACKGROUND Chronic health conditions are on the rise and are putting high economic pressure on health systems as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. Their treatment is highly interdisciplinary and regularly spans multiple care settings and organizations, thus placing particularly high demands on interoperable information exchange that can be achieved using international semantic standards such as SNOMED CT. OBJECTIVE This study aims to investigate the expressiveness of SNOMED CT in the domain of wound care, and thereby its clinical usefulness and the potential need for extensions. METHODS A clinically consented and profession independent wound care item set, the German National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped onto the international reference terminology SNOMED CT. Prior to the mapping, the NKDUC was transformed into an information model that served to systematically identify the relevant items. The mapping process itself was carried out in accordance with the formalism of ISO/TR 12300. As a result, the reliability, equivalence, and coverage rate were determined. RESULTS The developed information model revealed 268 items to be mapped. Conducted by three health care professionals, the mapping resulted in “moderate” reliability (K=0.512). Regarding the two best equivalence categories, the coverage rate of SNOMED CT was 67.2% overall and 64.3% specifically for wounds. CONCLUSIONS The results yielded acceptable reliability values for the mapping procedure. The overall coverage rate shows that two-thirds of the items could be mapped symmetrically, which is a substantial portion of the source item set. Some wound care sections, such as general medical condition and wound assessment, were covered better than other sections (wound status, diagnostics, and therapy). These deficiencies can be mitigated either by post-coordination or the inclusion of new concepts in SNOMED CT. This study contributes to pushing interoperability in the domain of wound care and thereby responds to the high demand for information exchange in this field. Overall, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.

Abstract 5921: Medicare Beneficiaries with Mild to Severe Heart Failure See 15–23 Different Providers Annually

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Robert L Page ◽  
Christopher Hogan ◽  
Kara Strongin ◽  
Roger Mills ◽  
JoAnn Lindenfeld
Keyword(s):  
Heart Failure ◽  
Severe Heart Failure ◽  
The United States ◽  
Outpatient Setting ◽  
Fiscal Year ◽  
Hospital Inpatient ◽  
Medicare Beneficiaries ◽  
Improvement Program ◽  
Data Set ◽  
Mild Disease

In fiscal year 2003, Medicare beneficiaries with heart failure (HF) accounted for 37% of all Medicare spending and nearly 50% of all hospital inpatient costs. On average, each beneficiary had 10.3 outpatient and 2 inpatient visits specifically for HF. Despite significant improvements in medical care for HF, mortality and hospital admissions remain high. No data exist regarding the number of providers ordering and providing care for this population. An analysis of fiscal year 2005 Medicare claims was conducted, using a 5% sample standard analytic and denominator file, limited data set version to extrapolate the 34,150,200 Medicare beneficiaries. Three cohorts were defined according to mild, moderate, severe HF employing the Centers for Medicare and Medicaid Services Hierarchical Condition Categories Model and Chronic Care Improvement Program definitions. HMO enrollees, persons without Part A and Part B coverage, and those outside the United States were excluded. We identified physicians by using the unique physician identification number of performing physicians. Based on inclusion criteria, 173,863 beneficiaries were identified. The average number of providers providing care in all sites were 15.9, 18.6, 23.1 for beneficiaries with mild, moderate, and severe HF, respectively; and 10.1, 11.5, and 12.1 in the outpatient setting, respectively. The average number of providers ordering care in all sites consisted of 8.3, 9.6, and 11.2 for beneficiaries with mild, moderate, and severe HF, respectively; and 6.5,7.3, and 7.8 in the outpatient setting, respectively. For beneficiaries with mild disease, only 10% of all office visits were specifically for HF, while those with moderate or severe disease, only 20% were specifically for HF. Medicare beneficiaries with HF, even those with mild disease, have a large number of providers ordering and providing care. These data highlight the importance for developing systems and processes of coordinated care for this population.

Is it possible to rank universities using fewer indicators? A study on five international university rankings

2019 ◽  
Vol 71 (1) ◽  
pp. 18-37 ◽  
Author(s):  
Güleda Doğan ◽  
Umut Al
Keyword(s):  
Similarity Measure ◽  
Decision Makers ◽  
Cosine Similarity ◽  
University Rankings ◽  
University Ranking ◽  
Data Set ◽  
Content Type ◽  
Research Questions ◽  
Cosine Similarity Measure ◽  
International University

Purpose The purpose of this paper is to analyze the similarity of intra-indicators used in research-focused international university rankings (Academic Ranking of World Universities (ARWU), NTU, University Ranking by Academic Performance (URAP), Quacquarelli Symonds (QS) and Round University Ranking (RUR)) over years, and show the effect of similar indicators on overall rankings for 2015. The research questions addressed in this study in accordance with these purposes are as follows: At what level are the intra-indicators used in international university rankings similar? Is it possible to group intra-indicators according to their similarities? What is the effect of similar intra-indicators on overall rankings? Design/methodology/approach Indicator-based scores of all universities in five research-focused international university rankings for all years they ranked form the data set of this study for the first and second research questions. The authors used a multidimensional scaling (MDS) and cosine similarity measure to analyze similarity of indicators and to answer these two research questions. Indicator-based scores and overall ranking scores for 2015 are used as data and Spearman correlation test is applied to answer the third research question. Findings Results of the analyses show that the intra-indicators used in ARWU, NTU and URAP are highly similar and that they can be grouped according to their similarities. The authors also examined the effect of similar indicators on 2015 overall ranking lists for these three rankings. NTU and URAP are affected least from the omitted similar indicators, which means it is possible for these two rankings to create very similar overall ranking lists to the existing overall ranking using fewer indicators. Research limitations/implications CWTS, Mapping Scientific Excellence, Nature Index, and SCImago Institutions Rankings (until 2015) are not included in the scope of this paper, since they do not create overall ranking lists. Likewise, Times Higher Education, CWUR and US are not included because of not presenting indicator-based scores. Required data were not accessible for QS for 2010 and 2011. Moreover, although QS ranks more than 700 universities, only first 400 universities in 2012–2015 rankings were able to be analyzed. Although QS’s and RUR’s data were analyzed in this study, it was statistically not possible to reach any conclusion for these two rankings. Practical implications The results of this study may be considered mainly by ranking bodies, policy- and decision-makers. The ranking bodies may use the results to review the indicators they use, to decide on which indicators to use in their rankings, and to question if it is necessary to continue overall rankings. Policy- and decision-makers may also benefit from the results of this study by thinking of giving up using overall ranking results as an important input in their decisions and policies. Originality/value This study is the first to use a MDS and cosine similarity measure for revealing the similarity of indicators. Ranking data is skewed that require conducting nonparametric statistical analysis; therefore, MDS is used. The study covers all ranking years and all universities in the ranking lists, and is different from the similar studies in the literature that analyze data for shorter time intervals and top-ranked universities in the ranking lists. It can be said that the similarity of intra-indicators for URAP, NTU and RUR is analyzed for the first time in this study, based on the literature review.

scholarly journals Prevention and therapy of acute and chronic wounds using NPWT devices during the COVID-19 pandemic, recommendation from The NPWT Working Group

2020 ◽  
Vol 7 (2) ◽  
Author(s):  
Tomasz Banasiewicz ◽  
Rolf Becker ◽  
Adam Bobkiewicz ◽  
Marco Fraccalvieri ◽  
Wojciech Francuzik ◽  
...  
Keyword(s):  
Wound Healing ◽  
Chronic Wounds ◽  
Hospital Admissions ◽  
Wound Care ◽  
Care Center ◽  
Management Strategies ◽  
Hospital Staff ◽  
Wound Management ◽  
Health Care Center ◽  
Single Use

Recent SARS-CoV-2 pandemic leading to a rapidly increasing number of hospitalizations enforced reevaluation of wound management strategies. The optimal treatment strategy for patients with chronic wounds and those recovering from emergency and urgent oncological surgery should aim to minimize the number of hospital admissions, as well as the number of surgical procedures and decrease the length of stay to disburden the hospital staff and to minimize viral infection risk. One of the potential solutions that could help to achieve these goals may be the extensive and early use of NPWT devices in the prevention of wound healing complications. Single-use NPWT devices are helpful in outpatient wound treatment and SSI prevention (ciNPWT) allowing to minimize in-person visits to the health care center while still providing the best possible wound-care. Stationary NPWT should be used in deep SSI and perioperative wound healing disorders as soon as possible. Patient’s education and telemedical support with visual wound healing monitoring and video conversations have the potential to minimize the number of unnecessary in-person visits in patients with wounds and therefore substantially increase the level of care.

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