August 29, 2011

JHU to review chronic wound treatment, identify best practices

An estimated $25 billion is spent annually on treating chronic wounds on patients in the United States. These chronic wounds deeply affect the quality of life of more than 6 million people who have them. The most common types of chronic skin wounds and skin ulcers are related to venous disease (conditions related to or caused by veins that become diseased or abnormal). Many treatment options are available, but the quality of evidence showing which treatments work better than others is often lacking. It is hard to prove which treatments are effective and should be the standards of care.

The Agency for Healthcare Research and Quality has now awarded the Johns Hopkins Evidence-based Practice Center a $475,000 project to carry out an extensive research review and create a scientific report to inform health care providers about effective state-of-the-art wound care. Through this project, the Johns Hopkins Wound Center and the Johns Hopkins Evidence-based Practice Center are conducting an evidence-based review of wound care to determine what is known and unknown about it, and to establish strategies of care that are proved to work.

Gerald Lazarus, founder of the Johns Hopkins Wound Center and professor of dermatology and medicine at Johns Hopkins Bayview Medical Center, and Jonathan Zenilman, newly named director of the Wound Center and professor of medicine and chief of the Division of Infectious Diseases at Johns Hopkins Bayview, are co–principal investigators of this study. Working with Eric Bass, director of the Johns Hopkins Evidence-based Practice Center, a team of recognized experts is trying to find important clinical answers to help treat patients with chronic wounds.

“This research is a unique and important study that underscores the scientific credibility and intellectual honesty of the Wound Center,” Lazarus said. “It’s a great example of how translational research affects everyday lives. The information we gather and present will help countless clinicians and patients to make better, more educated decisions about the best course of treatment to heal wounds.”

This type of study, known as comparative effectiveness research, is done to inform health care decision-makers by providing evidence on the effectiveness, benefits and risks of various treatment options. Johns Hopkins researchers will compile and analyze all the evidence available from existing clinical trials, clinical studies, literature and research about chronic wound care. This research will determine the value of therapeutic interventions—such as medications, antibiotics, dressings and surgery—for healing chronic wounds.

A report will show health care providers, patients and others which treatments work best under certain conditions. The report will be designed as an important tool for understanding the facts about different wound treatments. Its goal is to provide the best possible information about wound treatment choices that is easily usable so that health care providers can work with patients to make informed decisions about the right treatment plan for each wound.

Chronic wounds are a worldwide problem. Their prevalence and cost are increasing because of the aging population and more cases of obesity and diabetes. Chronic wounds often are associated with underlying conditions such as diabetes, clogging of the arteries, diseases of the veins, neurological problems, consequences of rheumatological illnesses, inflammation of vessels and other medical difficulties. Those that will not heal are frequently signs of larger and more complicated health problems. Nonhealing wounds can take a toll on patients far beyond the pain and discomfort of the wound. They can cause patients to lose their mobility, which may lead to a decline in general health and emotional well-being. Patients can become disabled, unable to work and dependent on care from others.

Christine Chang, medical officer of the Center for Outcomes and Evidence at the Agency for Healthcare Research and Quality, said that the topic of chronic venous ulcer treatments was nominated to AHRQ’s Effective Health Care Program by a consumer.

“The Johns Hopkins Evidence-based Practice Center is one of 14 centers in AHRQ’s Evidence-based Practice Center Program,” she said, “and has a core team with both clinical and systematic review expertise. It has assembled an excellent research team for this topic, and included individuals with extensive experience in the treatment and management of patients with chronic venous ulcers, as well as those skilled in systematic review methodology.”

Chang added, “While we do not formulate clinical practice guidelines, our hope is that this evidence report will provide patients and providers with the best information available to make well-informed decisions about care. The evidence report may also indicate areas of ongoing uncertainty, which will also be important as they consider various treatment options. We expect that clinician and consumer guides, as well as other translational materials, will be developed by our program, based upon the findings of the evidence report.”

The Johns Hopkins Wound Center is located at Johns Hopkins Bayview Medical Center and specializes in diagnosing and treating chronic wounds, preventing wound recurrence and preserving limbs.