Diabetic Foot and Pressure Ulcer Databank

说明： 慢性创面患者在治疗过程中由不同的临床医生护理。其中许多患者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。很少有临床医生有处理慢性伤口的专业知识，这就是为什么伤口解决率如此之低，发病率和死亡率如此之高的原因。医疗保健专业人员无论身在何处，都可以安全地访问与伤口相关的信息系统，这可能会改善伤口管理的临床决策，从而降低300多万患有压疮和糖尿病足部溃疡的患者的发病率和死亡率。这项研究的目的是开发和评估符合HIPAA标准的创伤电子病历，以确定它是否可以减少早期压疮(L-111)到IV期的进展，并降低与糖尿病足溃疡相关的截肢率。该计划的较长期目标是评估WEMR对整个医疗系统(包括医院、疗养院和伤口中心)的效用。 这项研究的研究假设是：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部溃疡相关的截肢数量。 为了实现这些假设，我们开发了WEMR，它包括伤口的照片、按面积测量的伤口愈合率的实时图表、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、活动状态以及放射学和病理学报告。WEMR已经在一家三级护理医院和门诊部的1600名连续患者中进行了Beta测试。初步数据表明：1)当压疮在发展到骨骼之前被诊断出来，并制定了适当的治疗方案，它们就会痊愈；2)糖尿病足溃疡，在没有缺血和骨髓炎的情况下，只要得到适当的治疗，就会痊愈，从而避免截肢。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，极大地促进了多个医疗保健提供者之间的临床护理协调，无论是在医院内还是从偏远地点。为了更明确地验证我们的假设，即使用WEMR加速伤口愈合，我们提出了一项在4个机构进行的多地点前瞻性队列研究：纽约大学、康奈尔大学和南区医院作为对照地点，哥伦比亚大学作为实验地点。鉴于这是一项非随机研究，该分析将使用倾向评分分层来调整不同地点患者的差异。我们聚集了伤口愈合、护理、医学、外科、流行病学和生物统计学领域的专家团队，在这项多地点研究中进行合作。这项拟议的研究提供了一个独特的机会，与不使用该信息系统的其他中心相比，系统地评估医院范围内的电子病历系统，并衡量其在降低IV期压疮发生率和减少与糖尿病足部溃疡相关的截肢方面的效果。

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.