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  • Measure Summary
  • NQMC:004411
  • Sep 2010

Chronic wound care: percentage of patient visits for those patients aged 18 years and older with a diagnosis of chronic skin ulcer without a prescription or recommendation to use wet to dry dressings.

American Society of Plastic Surgeons, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Chronic wound care physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 35 p. [19 references]

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patient visits for those patients aged 18 years and older with a diagnosis of chronic skin ulcer without a prescription or recommendation to use wet to dry dressings.

Rationale

A moist wound environment is essential to accelerate wound healing. Nevertheless, "wet to dry and gauze dressings are the most widely used primary dressing material in the United States" and evidence suggests that they are used inappropriately. In a recent study examining wound care practices, the use of dressings to maintain moist wound conditions ranged from 41.7% to 58.5% for diabetic and venous ulcers, respectively. Wet-to-dry dressings should not be utilized in the care of patients with chronic wounds as they may actually impede healing and are associated with an increased risk of infection, prolonged inflammation, and increased patient discomfort.

The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure:

Use clinical judgment to select a wound dressing that facilitates continued moisture. Wet-to-dry dressings are not considered continuously moist. Continuously moist saline gauze dressings are as effective as other types of moist wound healing in terms of healing rate, although they may have other drawbacks such as maceration of the peri-ulcer skin, practicality of use, and cost effectiveness. It can also be very difficult, practically, to keep gauze dressings continuously moist. (Wound Healing Society [WHS], 2006)

Maintain moist environment

  • Remove soluble factors detrimental to wound healing
  • Use appropriate dressings (available evidence shows no superiority in dressing materials)
  • Consider classic dressings (gauze, foam, hydrocolloid, hydrogels)
  • Consider bioactive dressings (American Society of Plastic Surgeons [ASPS], 2007)

Evidence for Rationale

American Society of Plastic Surgeons, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Chronic wound care physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 35 p. [19 references]

American Society of Plastic Surgeons. Evidence-based clinical practice guideline: chronic wounds of the lower extremity. Arlington Heights (IL): American Society of Plastic Surgeons; 2007 May. 21 p. [132 references]

Heale Armstrong M, Price P. Wet-to-dry gauze dressings: fact and fiction. Wounds. 2004;16(2):56-62.

Jones KR, Fennie K, Lenihan A. Evidence-based management of chronic wounds. Adv Skin Wound Care. 2007 Nov;20(11):591-600. [42 references] PubMed External Web Site Policy

Robson MC, Cooper DM, Aslam R, Gould LJ, Harding KG, Margolis DJ, Ochs DE, Serena TE, Snyder RJ, Steed DL, Thomas DR, Wiersma-Bryant L. Guidelines for the treatment of venous ulcers. Wound Repair Regen. 2006 Nov-Dec;14(6):649-62. PubMed External Web Site Policy

Steed DL, Attinger C, Colaizzi T, Crossland M, Franz M, Harkless L, Johnson A, Moosa H, Robson M, Serena T, Sheehan P, Veves A, Wiersma-Bryant L. Guidelines for the treatment of diabetic ulcers. Wound Repair Regen. 2006 Nov;14(6):680-92. PubMed External Web Site Policy

Whitney J, Phillips L, Aslam R, Barbul A, Gottrup F, Gould L, Robson MC, Rodeheaver G, Thomas D, Stotts N. Guidelines for the treatment of pressure ulcers. Wound Repair Regen. 2006 Nov-Dec;14(6):663-79. PubMed External Web Site Policy

Primary Health Components

Chronic wound care; chronic skin ulcer; wet to dry dressings

Denominator Description

All patient visits for those patients aged 18 years and older with a diagnosis of chronic skin ulcer (see the related "Denominator Inclusion/Exclusions" field)

Numerator Description

Patient visits without a prescription or recommendation to use wet to dry dressings

Note: Refer to the original measure documentation for administrative codes.

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Professional certification

Measurement Setting

Ambulatory/Office-based Care

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patient visits for those patients aged 18 years and older with a diagnosis of chronic skin ulcer

Note: Refer to the original measure documentation for administrative codes.

Exclusions
Documentation of medical reason(s) for prescribing/recommending the use of wet to dry dressings (e.g., presence of necrotic tissue requiring debridement, highly exudative wound that is unlikely to dry out between dressing changes)

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patient visits without a prescription or recommendation to use wet to dry dressings

Note: Refer to the original measure documentation for administrative codes.

Exclusions
None

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Measure #2: use of wet to dry dressings in patients with chronic skin ulcers (overuse measure).

Measure Collection Name

Chronic Wound Care Physician Performance Measurement Set

Submitter

American Society of Plastic Surgeons - Medical Specialty Society

Developer

American Society of Plastic Surgeons - Medical Specialty Society

National Committee for Quality Assurance - Health Care Accreditation Organization

Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Scott Endsley, MD, MSc (Co-Chair); William A. Wooden, MD, FACS (Co-Chair); Nicholas Biasotto, DO; Kathleen Lawrence, RN, MSN, CWOCN; Sergey V. Bogdan, MD; Andrew Maurano, PA-C; Stephen K. Bubb, MD; Mark Morasch, MD; H. Gunner Deery, II, MD, FACP, FIDSA; Jessica Pedersen, MBA, OTR/L, ATP; Dirk M. Elston, MD; Michael M. Priebe, MD; Elof Eriksson, MD; Aamir Siddiqui, MD; George Fueredi, MD; Carole (Carrie) Sussman, PT, DPT; Matthew G. Garoufalis, DPM; Amy Wandel, MD, FACS; Sarah Kagan, PhD, RN

American Society of Plastic Surgeons: Melanie Dolak, MHA

American Medical Association: Joseph Gave, MPH; Karen Kmetik, PhD; Shannon Sims, MD, PhD; Samantha Tierney, MPH

National Committee for Quality Assurance: Phil Renner, MBA

PCPI Consultants: Rebecca Kresowik; Timothy Kresowik, MD

Financial Disclosures/Other Potential Conflicts of Interest

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2010 Sep

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in January 2016.

Source(s)

American Society of Plastic Surgeons, Physician Consortium for Performance Improvement®, National Committee for Quality Assurance. Chronic wound care physician performance measurement set. Chicago (IL): American Medical Association (AMA); 2010 Sep. 35 p. [19 references]

Measure Availability

Source not available electronically.

For more information, contact the American Society of Plastic Surgeons (ASPS) at 444 E. Algonquin Rd., Arlington Heights, IL 60005; Phone: 847-228-9900; Fax: 847-709-7524; Web site: www.plasticsurgery.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on April 7, 2009. The information was verified by the measure developer on June 4, 2009.

This NQMC summary was retrofitted into the new template on May 13, 2011.

This NQMC summary was edited by ECRI Institute on April 27, 2012.

The information was reaffirmed by the measure developer on January 7, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For more information, contact Diedra D. Gray, Senior Manager, Quality and Health Policy, at the American Society of Plastic Surgeons, 444 E. Algonquin Rd., Arlington Heights, IL 60005; Phone: 847-228-3389.

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