Example of Wound Care Using Medpar Data

Author(s):  
Patricia Cerrito ◽  
John Cerrito

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.

2021 ◽  
Vol 30 (9) ◽  
pp. 722-728
Author(s):  
Rutger C Lalieu ◽  
Willem Mulder ◽  
René D Bol Raap ◽  
Saskia Stolk ◽  
Casper Smit ◽  
...  

Aim: Hard-to-heal diabetic foot ulcers (DFUs) may increase the risk of amputation. This study reports the positive influence of hyperbaric oxygen therapy (HBOT) on hard-to-heal DFUs involving underlying bone. Method: A single-centre, retrospective cohort study reporting the results of HBOT and wound care on hard-to-heal University of Texas grade 3 DFUs (i.e., involving underlying bone) between 2013 and 2019. Outcome measures were primarily (near-) complete wound healing (i.e., ≥80% ulcer surface area reduction) and amputation rate (minor or major), and secondarily the number of hyperbaric sessions and improvement in quality of life (QoL) and pain score. Results: The study included 206 patients, of whom 74 (36%) achieved complete wound healing, and 75 (36%) near-complete healing. Amputations were performed in 27 patients (13%): 12 (6%) minor and 15 (7%) major. The median number of HBOT sessions was 42. Participants who achieved complete healing received a median of 43 sessions, compared with 10 for those who required major amputation. Patients with at least 30 sessions were less likely to undergo amputation (odds ratio: 0.08; 95% confidence interval (CI): 0.03–0.21). Mean QoL increased by 7.6 points (95%CI: 3.9–11.3; p<0.01) and median pain score fell from 3 to 1 (0–3) (p<0.01). Conclusions: The addition of HBOT to standard wound care may lead to a decreased amputation risk, improved wound healing and increased QoL for people with a University of Texas grade 3 DFU. An adequate number of HBOT sessions is required to achieve optimal clinical results. Objective selection criteria and shared decision-making are suggested to improve dropout rates.


2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jillian Trieff Waller ◽  
Karen Borchert

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Kathrin H. Beckmann ◽  
Gesa Meyer-Hamme ◽  
Sven Schröder

Diabetic foot ulcers as one of the most common complications of diabetes mellitus are defined as nonhealing or long-lasting chronic skin ulcers in diabetic patients. Multidisciplinary care for the diabetic foot is common, but treatment results are often unsatisfactory. Low level laser therapy (LLLT) on wound areas as well as on acupuncture points, as a noninvasive, pain-free method with minor side effects, has been considered as a possible treatment option for the diabetic foot syndrome. A systematic literature review identified 1764 articles on this topic. Finally, we adopted 22 eligible references; 8 of them were cell studies, 6 were animal studies, and 8 were clinical trials. Cell studies and animal studies gave evidence of cellular migration, viability, and proliferation of fibroblast cells, quicker reepithelization and reformed connective tissue, enhancement of microcirculation, and anti-inflammatory effects by inhibition of prostaglandine, interleukin, and cytokine as well as direct antibacterial effects by induction of reactive oxygen species (ROS). The transferral of these data into clinical medicine is under debate. The majority of clinical studies show a potential benefit of LLLT in wound healing of diabetic ulcers. But there are a lot of aspects in these studies limiting final evidence about the actual output of this kind of treatment method. In summary, all studies give enough evidence to continue research on laser therapy for diabetic ulcers, but clinical trials using human models do not provide sufficient evidence to establish the usefulness of LLLT as an effective tool in wound care regimes at present. Further well designed research trials are required to determine the true value of LLLT in routine wound care.


2001 ◽  
Vol 91 (6) ◽  
pp. 275-279 ◽  
Author(s):  
Ronald A. Sage ◽  
Julie Kate Webster ◽  
Susan Gross Fisher

In a retrospective review of 233 cases of diabetic foot ulceration preceded by minor trauma, 192 ulcerations exhibited focal pressure keratosis as the preceding traumatic event. The frequency of outpatient visits and other foot care interventions were correlated with the occurrence and severity of ulceration. Patients seen more frequently in an outpatient foot clinic had less severe ulcers and were less likely to undergo surgical treatment than those with less frequent visits. (J Am Podiatr Med Assoc 91(6): 275-279, 2001)


2017 ◽  
Vol 41 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Ivana Roth-Albin ◽  
Safiah H.C. Mai ◽  
Zeeshan Ahmed ◽  
Ji Cheng ◽  
Karen Choong ◽  
...  

2021 ◽  
Author(s):  
Naser Parizad ◽  
Kazem Hajimohammadi ◽  
Rasoul Goli

Abstract BackgroundDiabetic foot ulcers, as one of the most debilitating complications of diabetes, can lead to amputation. Treatment and management of diabetic foot ulcers are among the most critical challenges for the patients and their families. Case presentationThe present case report is of a 63-year-old man with a 5-year history of uncontrolled type 2 diabetes who has had diabetic foot ulcers for the past three years on three sites of the left external ankle in the form of two deep circular ulcers with sizes of 6×4 cm and 6×8 cm, the sole as a superficial ulcer with a size of 6×3 cm, and the left heel as a deep skin groove. Moreover, the left hallux was completely gangrenous. The patient's ulcers were infected with Staphylococcus aureus and multidrug-resistant Pseudomonas aeruginosa. Despite antibiotic therapy and routine dressing changes, the patient showed no improvement during the hospital stay. Accordingly, the patient was transferred to our service after consulting with the wound management team. Diabetic foot ulcers were treated and managed using a combination of maggot therapy, the Negative Pressure Wound Therapy (NPWT), and silver foam dressing. After three months and ten days, the patient's ulcers completely healed, and he was discharged from our service with the excellent and stable condition. ConclusionsBased on the present case report study's clinical results, wound-care teams can use the combination therapy applied in this study to treat refractory diabetic foot ulcers.


Author(s):  
Fahruddin Kurdi ◽  
Ratna Puji Priyanti

ABSTRAK Jumlah penderita DM (diabetes melitus) saat ini semakin meningkat. Salah satu komplikasi yang terjadi yaitu DFU (diabetic foot ulcers). Banyak cara yang dapat dilakukan untuk mencegah DFU, salah satunya dengan diabetic foot exercise. Penelitian ini bertujuan untuk mengetahui efektifitas diabetic foot exercise terhadap risiko dfu (diabetic foot ulcers) pasien diabetes mellitus. Penelitian menggunakan design pre-eksperimen dengan pendekatan one-group pra-post test design. Populasi penderita diabetes yang berjumlah 60 orang, besar sampel 40 orang yang diambil menggunakan teknik purposive sampling. Resiko DFU dinilai menggunakan inlow’s 60-second diabetic foot screening tool dengan metode observasi. Analisa data menggunakan uji statistik Wilcoxon. Hasil penelitian ini didapatkan bahwa sebelum dilakukan diabetic foot exercise sebagian besar reponden mempunyai risiko sedang sebanyak 30 orang (75%), sesudah dilakukan diabetic foot exercise diperoleh bahwa sebagian besar responden risiko rendah sebanyak 32 orang (80%). Uji statistik Wilcoxon diperoleh nilai p value = 0,001 dimana nilai p value<α (0,05) yang berarti ada pengaruh diabetic foot exercise terhadap risiko diabetic foot ulcers. Diabetes foot exercise sangat efektif untuk penderita diabetes dalam mencegah risiko DFU. Penderita diabetes dapat melakukan diabetic foot exercise 2 kali dalam seminggu secara teratur.  Kata Kunci : Diabetes mellitus, Diabetic foot ulcers, diabetic foot exercise


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