Wound Interdisciplinary Teams (WIT): A Community- Based Pragmatic Randomized Controlled Trial (WIT)
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.
|Wound of Skin||Other: Systematic referral to MDWCT and comprehensive primary care|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Health Services Research
|Official Title:||Wound Interdisciplinary Teams (WIT): A Community- Based Pragmatic Randomized Controlled Trial|
- Time to Healing [ Time Frame: 6 months ]The primary clinical outcome measure will be time to healing, ascertained by digital wound photography using computer planimetry for wound measurement.
- proportion of wound healed [ Time Frame: 6 months ]proportion of wounds healed at 6 mths and the rate of wound healing(cm2/week).
- Wound recurrence [ Time Frame: 6 months ]Wound recurrence within the study period.
- time to discontinuation of wound service [ Time Frame: 1 years ]Time to discontinuation of wound services within the CCAC and interdisciplinary teams.
- Health Related Quality of Life (HRQOL) [ Time Frame: 6 months ]Health related quality of life.
- client satisfaction [ Time Frame: 6 months ]Satisfaction with care.
- cost and resource use [ Time Frame: 6 months ]cost and resource use of wound care provided
|Study Start Date:||May 2011|
|Study Completion Date:||October 2013|
|Primary Completion Date:||June 2013 (Final data collection date for primary outcome measure)|
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 Name: systematic expedited referral to MDWCTs
Please refer to this study by its ClinicalTrials.gov identifier: NCT01348841
|Toronto, Ontario, Canada, M5S 3M2|
|Principal Investigator:||Murray Krahn, PhD, MD||Director|