Many who work within the US-based wound care and hyperbaric medicine setting have come across the statement…”Our center has recently been recognized for achieving a wound healing rate of…”. Inserted in here are values in the 90th percentile, and as high as 98%. Those “in the know” will recognize these reports for what they are – made up numbers promulgated for no other reason than self-promotion. These “data”, however, target those “not in the know”, principally health care consumers, the regional medical community and purchasers of health care, who are collectively led to believe that better than nine out of every ten patients treated in these chronic wound care centers have healed. In many instances, hospital leadership are apt to assume these statements represent a true reflection of their wound center’s clinical performance. Nowhere is any information relating to wound center patient volume/the denominator, wound type including size and extent, comorbidities, or how sick patients were.
For almost a decade, NBS has sought to alert those “not in the know’ to what we and others believe is purposeful misrepresentation of health care outcomes data for financial gain. Click Here (1)
How are these remarkable results achieved?
How do centers publicizing these statistics generate such impressive healing outcomes? This is a particularly compelling question given that carefully controlled clinical studies, commonly involving less advanced wound states and invariably absent multiple co-morbidities associated with routine clinical practice, report healing rates in the order of 40%. (2) Fully transparent real world data is largely consistent with these scientifically substantiated outcomes. (3) The answer lies in creation of a manipulative database, where only a relatively modest subset of patients form the basis for what one is expected to believe represents the wound center’s entire population. One management company categorizes patients as four distinct types. First are the “outliers”. These patients have not healed within eight weeks. A second “palliative” group are those considered to have little likelihood of healing. Third is a “complex wound” category, representing patients with pre-existing conditions such as PVD, lymphedema, poorly controlled diabetes, etc., including poor compliance/transportation issues (arguably the common wound center patient). Finally, there are those assigned to “aggressive care”, defined as patients who healed within eight weeks. Only this latter group represent the center’s reported “healing rate”. No mention is made of outcomes data relates only to this latter subset of all the wound center’s patients. The NBS team has been privy to related data on several occasions, and it became apparent that 30 - 35% of patients make up the aggressive care category. If 95-99% of these patients fully responded, a not quite so impressive 28 - 33% overall healing rate would have been achieved.
Why does all of this matter?
Besides obvious ethical considerations related to misrepresentation of clinical performance, there are other issues regarding with made up healing rates. As noted, healing achieved in the ideal setting of randomized and controlled clinical trials involving patients with less severe wounds and exclusion of many common co-morbidities, sits within the 40th percentile. In essence, providers able to achieve similar healing rates in sicker patients with more complex wounds are, fact, excelling. Dr. Fife, with tongue only partially in cheek, argues that she would like to be the first wound care practitioner to brag about a 50% healing rate. Should these results be achievable and reported, what do you think the likely reaction of consumers who read that a competing center has healing wounds better than 90%? She, along with other ethical practitioners, would face an uphill referral battle until such time that honest and transparent reporting of risk-stratified wound type specific patients is required.
National Baromedical Services Position Statement at www.baromedical.com
Fife CE, Eckert KA, Carter MJ. Publically Reported Healing Rates: The Fantasy and the Reality. Advances in Wound Care 2018;7(3):77-94
Fife CE, Carter, MJ. Wound Care Outcomes and Associated Cost Among Patients Treated in US Outpatient Wound Centers: Data from the US Wound Registry. Wounds 2012; 24:10-17