Background: The care of patients with leg ulceration has developed over the p ast 15 years, although there is little information available to determine how th ese changes have affected clinical and patient defined out...Background: The care of patients with leg ulceration has developed over the p ast 15 years, although there is little information available to determine how th ese changes have affected clinical and patient defined outcomes. Objectives: To describe and evaluate the implementation of a leg ulcer strategy. Patients/metho ds: This study used a pre-and postimplementation evaluation within population -based services within the boundaries of community services providing leg ulce r care. Evidence-based leg ulcer services were developed, including standardiz ed assessment using Doppler ultrasound, rationalization of treatment using multi layer elastic high compression, development of referral criteria and acute servi ce support. Complete ulcer healing rates, health-related quality of life and u se of health resources were evaluated after 12 weeks in both pre-and postimple mentation cycles. Results: A total of 955 patients were evaluated (518 preimplem entation, 437 postimplementation). The levels of assessment and treatment were p oor prior to the change in practice with just one patient having evidence of cor rect assessment and 49 (11% ) receiving high compression therapy. Postimplement ation, this improved to 412 of 437 (94% ) having evidence of measurement of the ankle brachial pressure index, and 85% receiving compression. Twelve-week h ealing rates preimplementation ranged between 9% and 24% , and postimplementa tion rose from 19% to 39% . Combined overall healing rates improved from 71 o f 518 (14% ) to 160 of 437 (37% ), odds ratio = 3- 53, P < 0.00l. Frequency o f treatment visits reduced from a mean (SD) of 24.0 (16.1) over 12 weeks to 13.5 (8.6), P < 0.00l. Intervention led to major improvements in health-related qu ality of life (measured using the Nottingham Health Profile), with significant i mprovements for energy, pain, sleep and mobility (P < 0.0l). Conclusions: Rationalization of leg ulcer services through a total service change results in improvements in pr ofessional practice, better patient outcomes, and efficient use of current resou rces. This study highlights the importance of a multifaceted approach to improve practice focused on the needs of individual organizational settings.展开更多
文摘Background: The care of patients with leg ulceration has developed over the p ast 15 years, although there is little information available to determine how th ese changes have affected clinical and patient defined outcomes. Objectives: To describe and evaluate the implementation of a leg ulcer strategy. Patients/metho ds: This study used a pre-and postimplementation evaluation within population -based services within the boundaries of community services providing leg ulce r care. Evidence-based leg ulcer services were developed, including standardiz ed assessment using Doppler ultrasound, rationalization of treatment using multi layer elastic high compression, development of referral criteria and acute servi ce support. Complete ulcer healing rates, health-related quality of life and u se of health resources were evaluated after 12 weeks in both pre-and postimple mentation cycles. Results: A total of 955 patients were evaluated (518 preimplem entation, 437 postimplementation). The levels of assessment and treatment were p oor prior to the change in practice with just one patient having evidence of cor rect assessment and 49 (11% ) receiving high compression therapy. Postimplement ation, this improved to 412 of 437 (94% ) having evidence of measurement of the ankle brachial pressure index, and 85% receiving compression. Twelve-week h ealing rates preimplementation ranged between 9% and 24% , and postimplementa tion rose from 19% to 39% . Combined overall healing rates improved from 71 o f 518 (14% ) to 160 of 437 (37% ), odds ratio = 3- 53, P < 0.00l. Frequency o f treatment visits reduced from a mean (SD) of 24.0 (16.1) over 12 weeks to 13.5 (8.6), P < 0.00l. Intervention led to major improvements in health-related qu ality of life (measured using the Nottingham Health Profile), with significant i mprovements for energy, pain, sleep and mobility (P < 0.0l). Conclusions: Rationalization of leg ulcer services through a total service change results in improvements in pr ofessional practice, better patient outcomes, and efficient use of current resou rces. This study highlights the importance of a multifaceted approach to improve practice focused on the needs of individual organizational settings.
