Chronic wounds of the lower extremity: a preliminary performance measurement set

Chronic wounds of the lower extremity, a well-known condition with a high prevalence, high cost, variable practice pattern, and poor clinical outcome, are often managed by a nonintegrated health care system. The authors formed a multispecialty expert work group to draft a preliminary performance measurement set for the care of chronic wounds of the lower extremity.

The authors conducted a systematic review of existing scientific literature addressing the assessment and treatment of chronic wounds of the lower extremity. Admissible studies were screened using explicit threshold criteria and appraised for methodologic rigor against criteria promulgated by the Agency for Healthcare Research and Quality. Nine candidate performance measures emerged from the research synthesis. To estimate work group consensus and negate bias, the authors used latent class analysis.

A total of 55 clinical practice guidelines, 45 systematic reviews, three specialty society consensus statements, and seven health care technology assessments were reviewed. Only 46 were found to be of sufficient quality for use in measure development. Detailed specifications are reported for each performance measure, including period of assessment, method of reporting, sources of data, rationale, corresponding guidelines, and challenges to implementation.

The authors conclude that the peer-reviewed literature, imperfect as it is, well characterizes the core processes of care entailed in the assessment and treatment of chronic wounds of the lower extremity. The authors found ample support for the creation of an initial performance measurement set. Devoid of consensus among relevant specialty associations and key public and private stakeholder groups, however, this work is primitive.