Wound Interdisciplinary Teams (WIT): A Community- Based Pragmatic Randomized Controlled Trial
Study Details
Study Description
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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
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
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| No Intervention: Control Arm Usual care is care as currently delivered to clients with chronic wounds in the community. |
|
| Experimental: Intervention Arm 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. |
Other: Systematic referral to MDWCT and comprehensive primary care
Systematic referral to, and follow up, by Multi-Disciplinary Wound Care Teams (MDWCTs), co-ordinated by the Case Manager (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.
Other Names:
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Outcome Measures
Primary Outcome Measures
- 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
- proportion of wound healed [6 months]
proportion of wounds healed at 6 mths and the rate of wound healing(cm2/week).
- Wound recurrence [6 months]
Wound recurrence within the study period.
- time to discontinuation of wound service [1 years]
Time to discontinuation of wound services within the CCAC and interdisciplinary teams.
- Health Related Quality of Life (HRQOL) [6 months]
Health related quality of life.
- client satisfaction [6 months]
Satisfaction with care.
- cost and resource use [6 months]
cost and resource use of wound care provided
Eligibility Criteria
Criteria
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.
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Client (or substitute decision maker) provides written, informed consent.
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Someone in client's home (or substitute decision maker) must be able to speak English.
Exclusion Criteria:
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Surgical wounds
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Burns
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Malignant wounds
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Clients who are designated palliative on CCAC referral form
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | THETA Collaborative | Toronto | Ontario | Canada | M5S 3M2 |
Sponsors and Collaborators
- University of Toronto
- Ontario Ministry of Health and Long Term Care
Investigators
- Principal Investigator: Murray Krahn, PhD, MD, Director
Study Documents (Full-Text)
None provided.More Information
Publications
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