Wound healing outcomes: Using big data and a modified intent-to-treat method as a metric for reporting healing rates
Wound healing outcomes: Using big data and a modified intent-to-treat method as a metric for reporting healing rates
复制标题
DOI：
10.1111/wrr.12575
复制
发表时间：
2017-07-01
影响因子：
2.9
通讯作者：
Gordon, Hanna M.
中科院分区：
文献类型：
--
作者：
Ennis, William J.;Hoffman, Rachel A.;Gordon, Hanna M.
慢性伤口的患病率正在上升，对于美国医疗体系和整个世界来说，这是一个代价高昂的问题。通常，伤口护理领域的结果研究仅限于小型临床试验、比较有效性队列，并试图从索赔数据库中推断结果。因此，在现实世界的临床环境中的结果可能与这些已发表的研究不同。这项研究提出了一种改进的意图治疗框架，用于测量创伤结果，并测量两种不同环境下基于人群的结果的一致性。在这项回溯性的观察分析中，我们描述了迄今为止最大的患者伤口结果队列，这些结果来自626家医院诊所和一家学术三级护理诊所。我们介绍了创伤结局的改良意向治疗分析的结果以及人口统计学和描述性数据。在应用排除标准后，最终的分析样本包括国家样本中的667,291个伤口和学术样本中的1,788个伤口的结果。我们从626家诊所和77.6%的学术中心发现了一致的改良治疗意向，治愈率为74.6%。我们建议使用标准的改良意向治疗愈合率来报告伤口结果，以便在不同提供者、付款人和医疗保健系统的测量中实现一致性和可比性。
Chronic wounds are increasing in prevalence and are a costly problem for the US healthcare system and throughout the world. Typically outcomes studies in the field of wound care have been limited to small clinical trials, comparative effectiveness cohorts and attempts to extrapolate results from claims databases. As a result, outcomes in real world clinical settings may differ from these published studies. This study presents a modified intent-to-treat framework for measuring wound outcomes and measures the consistency of population based outcomes across two distinct settings. In this retrospective observational analysis, we describe the largest to date, cohort of patient wound outcomes derived from 626 hospital based clinics and one academic tertiary care clinic. We present the results of a modified intent-to-treat analysis of wound outcomes as well as demographic and descriptive data. After applying the exclusion criteria, the final analytic sample includes the outcomes from 667,291 wounds in the national sample and 1,788 wounds in the academic sample. We found a consistent modified intent to treat healing rate of 74.6% from the 626 clinics and 77.6% in the academic center. We recommend that a standard modified intent to treat healing rate be used to report wound outcomes to allow for consistency and comparability in measurement across providers, payers and healthcare systems.