DOMINATE Wounds
Chronic wounds are a significant health problem worldwide. Often they are initially managed with various focal treatments until a specialist becomes involved, sometimes weeks or months after treatment has begun. Even at the specialist level, practices and guidelines are inconsistent due to a lack of high-level evidence. A disease management system for chronic wounds that is simple, practical, and adoptable by a variety of wound care practitioners is needed. Such a system would guide wound care providers to address the critical aspects of wound care in a prioritized, systematic sequence, leading to faster healing of simple wounds, and timely advancement to more complex therapies for wounds that require such treatment. This paper describes an empirically developed wound care management system that has been successfully implemented and provides evidence-based rationale for each of its components. Relatively simple and practical, this system organizes an approach to any type of wound, routine or complex.
The field of wound care is rapidly expanding. Treatment options are continually being added to the armamentarium of wound care providers. Wound literature is steadily growing, practice guidelines are being developed, and industry is capitalizing on the widespread interest in the field. More evidence-based wound care recommendations are appearing and educational opportunities abound.
Chronic wounds are such a significant health problem worldwide that they are considered the "new global epidemic." These wounds are often initially managed with various focal treatments, commonly for weeks or months, until involving a specialist. Even then, practices are inconsistent among practitioners and clinics, and although numerous guidelines are available, they are also inconsistent, mainly due to the lack of high-level evidence. This situation indicates a need for a disease management system for chronic wounds that is simple, practical, and can be adopted by a broad variety of wound care practices. Such a system will guide wound care providers to address the aspects of wound care in a prioritized, systematic sequence and may lead to faster healing of simple wounds and timely advancement to more complex therapies for problematic wounds.
The purpose of this manuscript is to describe an empirically developed wound care management system that has been successfully implemented and to provide evidence-based rationale for each of its components. The elements are provided in the acronym DOMINATE and can be applied in most wound scenarios as a checklist to ensure that measures of proven efficacy are being used to encourage healing, which involves the orderly progression through 4 phases: hemostasis, inflammation, proliferation (repair), and maturation (remodeling). It can also serve as a clinical practice guideline to standardize management of chronic wound and makes sense in view of the prevalence and staggering cost of care of chronic, nonhealing wounds ( > $50 billion/year) in the United States alone. The implementation of the 2010 Affordable Care Act in the United States very likely will influence wound care by encouraging cost effectiveness through reimbursement formulae. Utilizing therapy proven to assist wound healing and employing clinical practice guidelines in a standardized approach to all wounds may become mandated or linked to reimbursement.
Abstract and Introduction
Abstract
Chronic wounds are a significant health problem worldwide. Often they are initially managed with various focal treatments until a specialist becomes involved, sometimes weeks or months after treatment has begun. Even at the specialist level, practices and guidelines are inconsistent due to a lack of high-level evidence. A disease management system for chronic wounds that is simple, practical, and adoptable by a variety of wound care practitioners is needed. Such a system would guide wound care providers to address the critical aspects of wound care in a prioritized, systematic sequence, leading to faster healing of simple wounds, and timely advancement to more complex therapies for wounds that require such treatment. This paper describes an empirically developed wound care management system that has been successfully implemented and provides evidence-based rationale for each of its components. Relatively simple and practical, this system organizes an approach to any type of wound, routine or complex.
Introduction
The field of wound care is rapidly expanding. Treatment options are continually being added to the armamentarium of wound care providers. Wound literature is steadily growing, practice guidelines are being developed, and industry is capitalizing on the widespread interest in the field. More evidence-based wound care recommendations are appearing and educational opportunities abound.
Chronic wounds are such a significant health problem worldwide that they are considered the "new global epidemic." These wounds are often initially managed with various focal treatments, commonly for weeks or months, until involving a specialist. Even then, practices are inconsistent among practitioners and clinics, and although numerous guidelines are available, they are also inconsistent, mainly due to the lack of high-level evidence. This situation indicates a need for a disease management system for chronic wounds that is simple, practical, and can be adopted by a broad variety of wound care practices. Such a system will guide wound care providers to address the aspects of wound care in a prioritized, systematic sequence and may lead to faster healing of simple wounds and timely advancement to more complex therapies for problematic wounds.
The purpose of this manuscript is to describe an empirically developed wound care management system that has been successfully implemented and to provide evidence-based rationale for each of its components. The elements are provided in the acronym DOMINATE and can be applied in most wound scenarios as a checklist to ensure that measures of proven efficacy are being used to encourage healing, which involves the orderly progression through 4 phases: hemostasis, inflammation, proliferation (repair), and maturation (remodeling). It can also serve as a clinical practice guideline to standardize management of chronic wound and makes sense in view of the prevalence and staggering cost of care of chronic, nonhealing wounds ( > $50 billion/year) in the United States alone. The implementation of the 2010 Affordable Care Act in the United States very likely will influence wound care by encouraging cost effectiveness through reimbursement formulae. Utilizing therapy proven to assist wound healing and employing clinical practice guidelines in a standardized approach to all wounds may become mandated or linked to reimbursement.