Diabetic Foot and Pressure Ulcer Databank

糖尿病足和压疮数据库

• 批准号: 6970116
• 负责人: HAROLD BREM
• 金额: $ 35.79万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2009-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6970116
• 关键词: amputation; automated medical record system; bioinformatics; clinical research; computer assisted patient care; decubitus ulcer; diabetes mellitus; disease /disorder classification; foot; health care service evaluation; health services research tag; human subject; outcomes research; pathologic process; patient care management; skin ulcer; wound healing

DESCRIPTION: Patients with chronic wounds are cared for by a variety of clinicians during the course of their treatment. Many of these patients seek treatment in different settings including hospitals, nursing homes, and out patient wound centers. Few clinicians have expertise in managing chronic wounds, which is why the wound resolution rate is so low, and the morbidity and mortality so high. A wound related informatics system that is secure and universally accessible by healthcare professionals, regardless of their geographic location, could potentially improve clinical decision making in the management of wounds and, consequently, decrease the morbidity and mortality in more than 3 million patients suffering from pressure ulcers and diabetic foot ulcers. The purpose of this study is to develop and evaluate a HIPAA compliant Wound Electronic Medical Record (WEMR) to determine if it can reduce the progression of early stage pressure ulcers (l-lll) to stage IV, and decrease the rate of amputations associated with diabetic foot ulcers. A longer term goal of this program is to evaluate the utility of the WEMR on an entire healthcare system (including hospitals, nursing homes, and wound centers). The research hypotheses of this study are: 1) the WEMR will significantly decrease the number of pressure ulcers that progress to stage IV and 2) the WEMR will significantly decrease the number of amputations associated with diabetic foot ulcers. To accomplish these hypotheses, we have developed the WEMR, which comprises of a photograph of the wound, a real-time graph of the wound's healing rate as measured by area, vascular testing, chemistry, hematology, microbiology laboratory values, current wound treatments, glycemic control, ambulatory status, and radiology and pathology reports. The WEMR has been beta-tested in 1600 consecutive patients in a tertiary care hospital and out patient unit. The preliminary data suggests: 1) that when pressure ulcers are diagnosed before they progress to bone and an appropriate treatment protocol is instituted, they heal; 2) diabetic foot ulcers, in the absence of ischemia and osteomyelitis, heal when they are treated appropriately, thereby averting amputations. The data from beta testing suggests that having all relevant patient information electronically available in one easily accessible record significantly facilitates coordination of clinical care among multiple health care providers, both on the hospital premises and from remote locations. To more definitively test our hypothesis that using the WEMR accelerates wound healing, we propose a multi-site prospective cohort study in 4 institutions: NYU, Cornell, and Southside Hospital as control sites and Columbia as the experimental site. Given that this is a nonrandomized study, the analysis will adjust for patient differences across sites using stratification by propensity scores. We have brought together a team of experts in the fields of wound healing, nursing, medicine, surgery, epidemiology and biostatistics to collaborate on this multi-site study. The proposed study offers a unique opportunity to systematically evaluate a hospital wide electronic medical record system and measure its effects on decreasing the incidence of stage IV pressure ulcers and decreasing amputations associated with diabetic foot ulcers as compared to other centers not using this informatics system.

产品说明： 患有慢性伤口的患者在治疗过程中由各种临床医生护理。这些患者中的许多人在不同的环境中寻求治疗，包括医院，疗养院和门诊伤口中心。很少有临床医生有管理慢性伤口的专业知识，这就是为什么伤口愈合率如此之低，发病率和死亡率如此之高。一个伤口相关的信息系统，是安全的和普遍访问的医疗保健专业人员，无论他们的地理位置，可能会改善临床决策的伤口管理，从而降低发病率和死亡率超过300万患者患有压力溃疡和糖尿病足溃疡。本研究的目的是开发和评估符合HIPAA的伤口电子病历（WEMR），以确定其是否可以减少早期压疮（I-III）进展到IV期，并降低与糖尿病足溃疡相关的截肢率。该计划的长期目标是评估WEMR在整个医疗保健系统（包括医院、疗养院和创伤中心）上的效用。 本研究的研究假设是：1）WEMR将显著减少进展到IV期的压疮数量，2）WEMR将显著减少与糖尿病足溃疡相关的截肢数量。 为了实现这些假设，我们开发了WEMR，其包括伤口照片、通过面积测量的伤口愈合率的实时图、血管测试、化学、血液学、微生物学实验室值、当前伤口治疗、血糖控制、动态状态以及放射学和病理学报告。WEMR已经在三级医院和门诊部的1600名连续患者中进行了β测试。初步数据显示：1）当压力性溃疡在发展到骨之前被诊断出来并且制定适当的治疗方案时，它们会愈合; 2）糖尿病足溃疡，在没有缺血和骨髓炎的情况下，当它们被适当治疗时会愈合，从而避免截肢。来自beta测试的数据表明，在一个易于访问的记录中以电子方式提供所有相关的患者信息，这大大促进了医院和偏远地区多个医疗保健提供者之间的临床护理协调。为了更明确地检验我们的假设，即使用WEMR加速伤口愈合，我们提出了一项在4个机构进行的多中心前瞻性队列研究：纽约大学、康奈尔大学和Southside医院作为对照中心，哥伦比亚作为实验中心。鉴于这是一项非随机化研究，分析将使用倾向评分分层调整各研究中心的患者差异。我们汇集了伤口愈合、护理、医学、外科、流行病学和生物统计学领域的专家团队，共同开展这项多中心研究。拟议的研究提供了一个独特的机会，系统地评估医院范围内的电子病历系统，并测量其对降低IV期压疮的发生率和减少与糖尿病足溃疡相关的截肢的影响，与其他不使用该信息系统的中心相比。