Family Practice Advance Access published online on June 29, 2007
Family Practice, doi:10.1093/fampra/cmm024
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Cost-effectiveness of multidisciplinary wound care in nursing homes: a pseudo-randomized pragmatic cluster trial
a Centre for Health Economics, Monash University, Clayton, Victoria
b Department of Pharmacy Practice, Monash University, Clayton, Victoria
c Wound Foundation of Australia, Monash University, Parlville, Victoria, Australia. Correspondence to Trang Vu, Building 75, Monash University Clayton Campus, Wellington Road, Clayton 3800, Victoria, Australia
Email: trang.vu{at}buseco.monash.edu.au
Received 19 June 2006; Revised 21 March 2007; Accepted 30 April 2007.
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Abstract |
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Objectives. To evaluate the cost-effectiveness of a multidisciplinary wound care team in the nursing home setting from a health system perspective.
Methods. Pseudo-randomized pragmatic cluster trial with 20-week follow-up involving 342 uncomplicated leg and pressure ulcers in 176 residents located in 44 high-care nursing homes in Melbourne, Australia in 1999–2000. Twenty-one nursing homes (180 wounds in 94 residents) were assigned to the intervention arm and 23 to the control arm (162 wounds in 82 residents). Residents in the intervention arm received standardized treatment from a wound care team comprising of trained community pharmacists and nurses. Residents in the control arm received usual care.
Results. More wounds healed during the trial in the intervention arm than in the control arm (61.7% versus 52.5%, P = 0.07). A Cox regression with shared frailty predicted that the chances of healing increased 73% for intervention wounds [95% confidence interval (CI) 20–150%, P = 0.003]. The mean treatment cost was $A616.4 for intervention and $A977.9 for control patients (P = 0.006). Most cost reduction was obtained from decreases in nursing time and waste disposal. The mean cost saving per wound, adjusted for baseline wound severity and random censoring, was $A277.9 (95% CI $A21.6–$A534.1).
Conclusions. Standardized treatment provided by a multidisciplinary wound care team saved costs and improved chronic wound healing in nursing homes. The main source of saving was in the cost of nursing time in applying traditional dressings and in the cost of their disposal.
Keywords. Chronic wounds, cluster trial, cost-effectiveness, multidisciplinary, nursing homes.
Vu T, Harris A, Duncan G, Sussman G. Cost-effectiveness of multidisciplinary wound care in nursing homes: a pseudo-randomized pragmatic cluster trial. Family Practice 2007; Pages 1–8 of 8.
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