Shifting the distribution curve for healthcare resource use through topical oxygen therapy for wound healing
Abstract: The clinical and economic burden associated with hard-toheal wounds is high and evidence suggests that it continues to increase. Healthcare resources consumed during the provision of wound care can be saved by implementing strategies and actions aimed at promoting wound healing. When these are successful, the frequency distribution curve for time to healing and for the consumption of healthcare resources should ‘move to the left’ and the extent to which it is ‘skewed to the right’ would be reduced, resulting in a reduction in the population mean for time to wound healing, and correspondingly, healthcare resources. Not only would this release healthcare resources in the short term, but, if these changes are maintained, would render savings sustainable, thereby contributing to lowering the overall burden of wounds and wound care. In this article, we present evidence that suggests that the adoption of adjunct topical haemoglobin spray can effect these desired changes in the wound healing curve and, due to the nature of the technology, it can be easily and sustainably implemented within relevant whole populations requiring wound care. The ease of adoption and impact is further illustrated by a patient case study. Declaration of interest: PA and FE are consultants of Mölnlycke Healthcare. GB is an employee of Mölnlycke Healthcare. The remaining authors have no conflicts of interest to declare.
chronic ● distribution curve ● economic burden ● hard-to-heal ● haemoglobin spray ● healthcare resource ● sustainable healthcare ● topical oxygen therapy ● wound ● wound care ● wound healing
It is often the case that a relatively small number of patients consume a disproportionately large share of healthcare resources. The distribution of such healthcare resources has been extensively reviewed1–4 and is invariably ‘skewed to the right’, with a population mean resource use that is much higher than the median.1–4 Wound care is one of five examples of ‘skewing to the right’ highlighted by Briggs and Gray1 using data from patients with venous leg ulcers (VLUs) receiving standard care. Many wound care publications report on a proportion of patients where wound healing happens faster than the population mean, a proportion of patients where wound healing happens in and around the population mean, and a proportion of patients where would healing happens much slower than the population mean, supporting the notion that the wound care resource utilisation curve is ‘skewed to the right’.5–7
Lindholm and Searle5 provided an example of a population where 24% of wounds took six months to
Paulo Alves,1*; Fredrik Elg,2; Gerhard Bothma,3; Ana Oliveira,4; João Neves-Amado,1; João Amado,1 *Corresponding author email: email@example.com 1 Universidade Católica Portuguesa, Institute of Health Sciences, Wounds Research Lab, Center for interdisciplinary Research in Health, Oporto, Portugal. 2 Pracipio, London, UK. 3 Mölnlycke AB, Gothenburg, Sweden. 4 Universidade Católica Portuguesa, CBQF – Centro de Biotecnologia e Química Fina, Laboratório Associado, Escola Superior de Biotecnologia, Oporto, Portugal.
heal, while 16% took ≥1 year. Similarly, Milne et al.,6 quote data where between 35–39% of wounds are termed ‘static’ and/or ‘hard-to-heal’, and that these type sof wounds would be typical in most wound care populations. Guest et al.7 reported that 30% of patients in their study failed to heal within one year, while Fife et al.8 found that 55–70% of hard-to-heal wounds across a range of studies on best standard care failed to heal within 12 weeks.
The longer the wound healing time, the more healthcare resources tend to be consumed. A study in the UK suggested that >60% of wound care resources were consumed by wounds that were not healed in an average of one year,9 and, by implication, more than doubling the overall cost of wound treatment.7 Lindholm and Searle5 identify the lack of timely wound healing as one of the main drivers of the cost of wound care. Fig 1 illustrates the relationship between wounds healed, frequency distribution of time to healing, and mean cost of healthcare resources per (unhealed) wound.
A setting with better healing outcomes, more wounds healed and faster healing, consumes relatively less of the healthcare resources associated with the provision of wound care, and will have a wound care resource utilisation curve less skewed to the right, with fewer hard-to-heal wounds remaining unhealed, and therefore consuming fewer healthcare resources. Hence, by improving outcomes at the patient level, savings can be effected at the population level, aligning to the Porter
JOURNAL OF WOUND CARE VOL 31, NO 3, MARCH 2022