Wound Interdisciplinary Teams (WIT): A Community- Based Pragmatic Randomized Controlled Trial

Not Applicable

Completed

Interventions: Other: Systematic referral to MDWCT and comprehensive primary care

Brief Summary: Wounds that are slow to heal (chronic) may be managed in different ways. In Ontario, care in the community for most of these is coordinated by the local Community Care Access Centre (CCAC). One or more health professionals might deliver treatment, individually or as part of a wound care team, with different members having different kinds of training (interdisciplinary team), which may or may not include wound care. Community treatment by interdisciplinary teams has been shown to be more effective and cost-effective for some long-standing health problems, but further scientific evidence is needed to determine if this is also true for chronic wounds.

This study compares the usual way chronic wounds are being managed in the community with a so-called "intermediate care" approach. In this study, intermediate care will involve health service providers following certain agreed-upon steps (evidence-based best practice) from first contact with the client through assessment, treatment, and on to referral to a hospital specialty wound care team, if needed.

Detailed Description: For certain types of chronic illness, planning case management and providing care according to evidence-based guidelines (published methods that have been supported scientifically) results in better clinical outcomes and better cost-effectiveness. Wound management by interdisciplinary teams may have these advantages in both the community primary care setting and the hospital specialized care setting. Systematic review of the literature indicated that the evidence was incomplete to support implementation of an intermediate care model for community management of chronic wounds. Therefore, the Ontario Health Technology Advisory Committee recommended that a field evaluation be conducted to provide stronger evidence about the relative effectiveness, cost-effectiveness and feasibility of managing chronic wounds in the community using both standardized, comprehensive primary care and a systematic method of referral to a specialty, multidisciplinary team based in a hospital

Recruitment & Eligibility

Inclusion Criteria

Adult (>18 years of age) client with eligible wound type (not surgical, malignant or burns) referred to the Toronto Central CCAC for wound management.
Client (or substitute decision maker) provides written, informed consent.
Someone in client's home (or substitute decision maker) must be able to speak English.

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Intervention Arm	Systematic referral to MDWCT and comprehensive primary care	Systematic referral to MDWCT and comprehensive primary care: Intervention consists of systematic referral to MDWCT in conjunction with comprehensive primary care.Systematic referral to, and follow up, by MDWCTs, co-ordinated by the CM, will occur.There will be immediate referral to the MDWCT of clients with :1/ diabetic lower extremity ulcers,2/peripheral neuropathy, charcot changes,3/wound present longer than 4 mths. ,4/ Ankle Brachial Index less than 0.6, non-diabetics, and not being seen by a vascular surgeon. Subsequent referral to MDWCT will occur if less than 30% healing by week 4.

Primary Outcome Measures

Name	Time	Method
Time to Healing	6 months	The primary clinical outcome measure will be time to healing, ascertained by digital wound photography using computer planimetry for wound measurement.

Secondary Outcome Measures

Name	Time	Method
Wound recurrence	6 months	Wound recurrence within the study period.
Health Related Quality of Life (HRQOL)	6 months	Health related quality of life.
cost and resource use	6 months	cost and resource use of wound care provided
proportion of wound healed	6 months	proportion of wounds healed at 6 mths and the rate of wound healing(cm2/week).
time to discontinuation of wound service	1 years	Time to discontinuation of wound services within the CCAC and interdisciplinary teams.
client satisfaction	6 months	Satisfaction with care.