The effectiveness of advanced practice registered nurses with wound care specialization in the home setting on wound resolution and healthcare utilization

Abstract

Objective: The purpose of this study was to evaluate the effectiveness of advanced practice registered nurses (APRNs) with wound specialization on wound resolution and healthcare (HC) utilization for home health patients.
Methods: A quasi-experimental design with a convenience sample of 30 participants admitted to home health (HH) services compared to a retrospective chart review of 46 participants matched in terms of volume, wound type, wound size, gender, and age was used during the study. The APRN conducted a physical exam and history, obtained wound photography, developed a treatment plan, performed therapy, wrote orders for products and services, and provided a minimum of weekly follow-up visits. Healthcare utilization comprised time for healing, admits to a higher level of care, and amputations. Wound resolution was observed at 80% and 100% closure.
Results: The Intervention and Control Groups were comparable in terms of gender, wound type, age, and acuity, were similar regarding wounds per patient. Both groups achieved 80% volume, 80% area, and 100% wound resolution, regardless of wound types. The Intervention Group’s days to wound resolution was statistically significant for fewer days than the Control Group. This difference persisted after analysis of wound types within the groups. The Intervention Group had fewer acute care admits (10%) compared to the Control Group (50%), and the number of amputations was higher in the Control Group, with six amputations compared to only one in the Intervention Group.
Conclusions: Using APRNs with wound specialization improved patient outcomes, efficiency, and costs. The program should be evaluated for adoption and expansion. Further research into the impact of wound-specialized APRNs in the home setting is recommended.

Keywords

APRN / Wound specialization / Wound care / Home health

ACKNOWLEDGEMENTS

The authors would like to acknowledge the many contributions made by the Medicare Advantage team members who participated in this study who provided advisement, along with patient supervision including Shelly Gupta, MD, Maria Treme, MD, Brandon Poche, RN, BS, Geoff Clement, RN, BSN, Katrina Griffin, RN, BSN, CMCN, Shawn Moran, RN, Victoria Pompey-Encalade, RN, Kendra Gaudet RN and Harris, Blackman, MD.

CONFLICTS OF INTEREST DISCLOSURE

The authors declare they have no conflicts of interest.

References

[1] Batas R. Community nursing care for chronic wounds: a case study of optimal home treatment of a venous leg ulcer. J Wound Ostomy Continence Nurs. 2019; S32-39. https://doi.org/10.12968/gasn.2019.17.Sup5.S32

[2] Tripathi R, Knusel KD, Ezaldein HH, et al. Incremental health expenditure of chronic cutaneous ulcers in the United States. JAMA Derm. 2019; 155(6): 694-699. PMid: 30892572. https://doi.org/10.1001/jamadermatol.2018.5942

[3] Font-Jiménez I, Llaurado-Serra M, Roig-Garcia M, et al. Retrospective study of the evolution of the incidence of non-traumatic lower-extremity amputations (2007-2013) and risk factors of reamputation. Prim Care Diabetes. 2016 Dec; 10(6): 434-441. PMid: 27184825. https://doi.org/10.1016/j.pcd.2016.04.001

[4] Paisey RB, Abbott A, Paisey CF, et al. Diabetic foot ulcer incidence and survival with improved diabetic foot services: an 18-year study. Diabet Med. 2019 Nov; 36(11): 1424-1430. PMid: 31150130. https://doi.org/10.1111/dme.14045

[5] Pérez MB, López-Casanova P, Lavín RS, et al. Epidemiology of venous leg ulcers in primary health care: incidence and prevalence in a health centre-A time series study (2010-2014). Int Wound J. 2019 Feb; 16(1): 256-265. PMid: 30393963. https://doi.org/10.1111/iwj.13026

[6] Sen CK. Human wounds and its burden: an updated compendium of estimates. Adv Wound Care. 2019 Feb; 8(2): 39-48. PMid: 30809421. https://doi.org/10.1089/wound.2019.0946

[7] Sen CK. Human wound and its burden: updated 2020 compendium of estimates. Adv Wound Care. 2021 May; 10(5): 281-292. PMid: 33733885. https://doi.org/10.1089/wound.2021.0026

[8] Welsh L. Wound care evidence, knowledge and education amongst nurses: a semi-systematic literature review. Int Wound J. 2017; 15: 53-61. https://doi.org/10.1111/iwj.12822 PMid:29045004 PMCid:PMC7949797

[9] Gallagher MA, Chraplyvy N. Building a business case for hiring wound, ostomy, and continence nurses. Adv In Skin & Wound Care. 2022 Sept; 35(9): 493-8. https://doi.org/10.1097/01.ASW.0000855028.36575.dc PMid:35993858

[10] Coppa D, Winchester SB, Roberts MB. Home-based nurse practitioners demonstrate reductions in rehospitalizations and emergency department visits in a clinically complex patient population through an academic-clinical partnership. J Am Assoc Nurse Pract. 2018 Jun; 30(6): 335-343. https://doi.org/10.1097/JXX.0000000000000060 PMid:29878967

[11] Jones MG, DeCherrie LV, Meah YS, et al. Using nurse practitioner co-management to reduce hospitalizations and readmissions within a home-based primary care program. J Healthc Qual. 2017 Sep/Oct; 39(5): 249-258. https://doi.org/10.1097/JHQ.0000000000000059 PMid:27631706 PMCid:PMC5348286

[12] Larsen T, Zeni MB. An evaluation of a wound provider program - Wound Ostomy Continence Nurs Soc’s 49th Annual Conference. Salt Lake City, Utah; May 19-23, 2017. Available from: https://journals.lww.com/jwocnonline/fulltext/2017/05001/scientific_and_clinical_abstracts_from_the_wocn_.1.aspx

[13] Rantz JM, Popejoy L, Vogelsmeier A, et al. Impact of advanced practice registered nurses on quality measures: the Missouri Quality Initiative Experience. J Am Med Dir Assoc. 2018; 19(6): 541-550. https://doi.org/10.1016/j.jamda.2017.10.014 PMid:29208447

[14] Taidouch A, Crouwers MJ, Spigt M. Complex wound care by a nurse practitioner in primary care: a quality improvement evaluation on healing rates, costs and patient satisfaction. Br J Community Nurs. 2021 Dec; 26(Sup12): S14-S21. PMid: 34881648. https://doi.org/10.12968/bjcn.2021.26.Sup12.S14

[15] Trilla F, DeCastro T, Harrision N, et al. Nurse practitioner home-based primary care program improves patient outcomes. J for Nurs Pract. 2018 Oct; 14(9): e185-e188. https://doi.org/10.1016/j.nurpra.2018.08.003

[16] Wolff-Baker D, Ordona RB. The Expanding Role of Nurse Practitioners in Home-Based Primary Care: Opportunities and Challenges. J Gerontol Nurs. 2019 June; 45(6): 9-14. PMid: 31135933. https://doi.org/10.3928/00989134-20190422-01

[17] Gonzalez A, Delgado V, Buscemi CP. Wound Closure Rates: A Comparison Between Advanced Practice Registered Nurse and Primary Care Physician Treatment. J Nurs Pract. 2019; 15(9): e173-e176. https://doi.org/10.1016/j.nurpra.2019.04.015

[18] Louisiana State Board of Nursing . Scope of Practice for Nurse Practitioners. 2015. Available from: http://www.lsbn.state.la.us/NursingPractice.aspx

[19] World Health Orgainzation . International statistical classification of diseases and related health problems. 10th rev 5th ed. 2016. Available from: https://www.who.int/publications/m/item/official-who-icd-10-updates-2016-package

[20] Brennan MB, Powell WR, Kaiksow F, et al. Association of Race, Ethnicity, and rurality with major leg amputation or death among Medicare beneficiaries hospitalized with diabetic foot ulcers. JAMA Netw Open. 2022; 5(4): e228399. PMid: 35446395. https://doi.org/10.1001/jamanetworkopen.2022.8399

[21] Akinlotan MA, Primm K, Bolin JN, et al. Racial, rural, and regional disparities in Diabetes-related lower-extremity amputation rates, 2009-2017. Diabetes Care. 2021; 44(9): 2053-2060. PMid: 34301733. https://doi.org/10.2337/dc20-3135