Despite 76% of patients referred for home health care being denied in 2022 (a 22% increase from 2019), we know health care is moving home with an increase in HHA referral volumes by 11% since 2020. Concurrently, the concept of "Hospital at Home" (HaH) has been gaining traction globally as healthcare systems seek innovative ways to deliver care efficiently and effectively. Increasing interest and investment in this care delivery model suggest a promising trajectory for its expansion in the coming years, with significant growth currently being realized.
Addressing the Complexities of Wound Care in Home Health
As health care is moving home, home health providers and clinicians constantly strive to provide the best care possible while facing unique challenges. In the home healthcare setting, the scarcity of board-certified wound and ostomy nurses poses a significant hurdle. With less than 10% practicing in the post-acute space, finding these specialized nurses can be daunting. Thus, identifying avenues to access WOC nurses becomes crucial for ensuring high-quality wound care delivery in home care settings. Wound management in the home presents several unique challenges:
- Limited Resources: Home environments may lack the same resources available in healthcare facilities, such as specialized wound care equipment, supplies, and skilled personnel. This scarcity can hinder the delivery of optimal wound care.
- Patient Mobility: Homebound patients may have limited mobility, making it difficult for them to access healthcare services or attend regular appointments. This can lead to delays in wound assessment and treatment, potentially exacerbating their condition.
- Caregiver Training: Family members or caregivers responsible for wound care at home may lack proper training or education in wound management techniques. Without adequate knowledge, there's a risk of improper wound care practices, which can impede healing or cause complications.
- Infection Control: Maintaining proper hygiene and infection control measures in the home environment can be challenging, increasing the risk of wound infections. Factors such as limited access to clean water, sanitation facilities, and sterile supplies may contribute to this challenge.
- Communication and Coordination: Effective communication and coordination between healthcare providers, patients, and caregivers are essential for successful wound management. However, in the home setting, communication barriers and fragmented care coordination may arise, leading to gaps in care and suboptimal clinical and financial outcomes.
- Environmental Factors: Home environments vary widely in terms of cleanliness, temperature, humidity levels, and other environmental factors that can influence wound healing.
- Compliance and Follow-up: Ensuring patient compliance with wound care instructions and follow-up appointments can be problematic in the home setting. Factors such as forgetfulness, cognitive impairment, or lack of understanding of the importance of wound care may contribute to non-compliance, hindering the healing process.
Addressing these challenges requires a comprehensive approach that involves patient education, caregiver support, interdisciplinary collaboration, and innovative solutions to overcome barriers to wound management in the home.
While evidence-based guidelines provide a foundation, effective wound care demands individualized strategies. Despite advancements in technology, there's no substitute for the wound care clinicians’ expertise, experience, and critical thinking skills. They play an irreplaceable role in navigating the complexities of wound management and optimizing patient outcomes.
Wounds present complex challenges, and patient care plans hinge on multiple factors. Considerations include the care setting, available resources, wound etiology, patient comorbidities, and the specific characteristics of the wounds themselves. Expertise is essential in crafting customized treatment plans that promote healing and improve quality of life. While tools and guidelines are valuable, they must be complemented by clinical expertise to achieve optimal outcomes.
Comprehensive Wound Assessment and Management: The Role of WOC Nurses
Firstly, it's essential to assess the patient's environment: Where are they receiving care, and who is administering routine wound care? Once environmental factors and social determinants of health are considered, attention shifts to the wounds themselves. Wound location(s), age of wounds(s), and underlying causes (etiologies) of each wound are critical. Assessments delve into wound bed characteristics, such as size, tissue type, and depth of injury. Other crucial aspects include the presence of tunneling or undermining, the nature of wound drainage (amount, color, consistency, and odor), the condition of wound edges, and the integrity of surrounding skin.
Moreover, signs of infection or deterioration, patient-reported pain levels, and healing expectations guide treatment decisions. Determining the need for debridement or additional diagnostic tests is vital for accurate management. Comorbidities and medications must also be evaluated, as they can impact healing and influence treatment plans.
For chronic wounds, especially those persisting beyond six months, considerations may extend to potential complications like osteomyelitis or circulatory issues. Addressing non-healing wounds requires a comprehensive approach, often involving specialists and tailored interventions.
WOC nurses are invaluable in situations where wound healing is challenging, and a palliative approach is indicated. Their expertise ensures the development of cost-effective treatment plans that safeguard patients from infection and decline, ultimately enhancing their quality of life.
Analyzing Wound Care Data: Hospitalization Rates, Visit Utilization, and Documentation Discrepancies
We know from the Home Health 2020-2022 Strategic Healthcare Programs (SHP) primary wound data review of over 2.7 million 30-day episodes of care that wounds drive almost a 30% higher rate of hospitalization overall clinical groups and both 30-Day Rehospitalization & 60-Day Hospitalization Rates have remained consistent over the 3-year period. 30-Day Rehospitalization rates for all clinical groups in 2022 at 11.6% and at 15.4% for the wound clinical group. 60-Day Hospitalization Rate at 13.7% and wound clinical group at 18.2%. The SHP data also shows us that wounds typically drive higher skilled nurse visit utilization at 16.7 visits per stay versus 7.0 for all clinical groups in 2022. However, the implementation of virtual wound care expertise, like the HRS WoundConnect service, has led agencies to report a reduction of up to 50% in visit utilization for their wound care patients.
Additionally, in the #1 primary wound diagnosis category of pressure injuries, the SHP data demonstrated higher than expected average length of stay for less severe pressure injuries of stage 1 and stage 2 at 68.5 and 78.5 days. This identifies a significant discrepancy between expected healing times (of 2-3 days and 23-31 days) and this average LOS. This discrepancy suggests inaccurate staging at SOC and/or treatment of pressure injuries.
A final key SHP wound data finding related to the #8 top wound diagnosis of non-pressure chronic ulcer and showed that 31% of episodes were not properly documented in order to receive the wound grouping reimbursement as they did not provide specific documentation to include severity, location, and laterality. Additionally, this diagnosis is associated with an average 87.7-day length of stay vs wound group average length of stay of 61.4 days suggesting lack of use of evidence-based treatment plans relative to this nondescript wound diagnosis is associated with poor outcomes.
Embracing Telehealth and Remote Patient Monitoring: The Future of Wound Care Management
In partnering with Health Recovery Solutions to deploy WoundConnect, a service providing remote access to experienced wound ostomy care nurses, providers offer a cost-effective solution to address the multifaceted challenges of wound management, ensuring patients receive high-quality, tailored care. The involvement of WOC nurses is crucial in developing cost-effective treatment plans that optimize patient outcomes and quality of life. Value-based providers seek partners who can ensure better care outcomes at lower costs per patient. Telehealth and RPM bridges the gaps in access to board-certified wound care clinicians in the home and across the continuum.