Leveraging information from many to better serve the individual: A healthcare tool for personalized prioritization of Clinical Practice Guidelines in pressure injury management.
1Bogie K, 2Henzel K, 3Zhang G, 3Roggenkamp S, 4Sun J, 4Bloostein A, 2Seton J, 2Richmond M, 2Washington M, 2McDaniel J, 2Graebert J, 2Lemmer D, 2Schwartz K
1Case Western Reserve University/Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA; 2Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA; 3University of Kentucky, Nashville, TN, USA; 4Case Western Reserve University, Cleveland, OH, USA
Clinical practice guidelines (CPG) have identified many evidence-based risk factors for primary and secondary pressure injury (PrI) prevention in individuals with spinal cord injury (SCI). Risk factors arise from multiple domains, encompassing everything from the home environment to the blood flow in the buttock region when seated in the wheelchair. Primary prevention seeks to prevent initial PrI development, while secondary prevention seeks to decrease chronic recurrence for the individual. CPG combine evidence based practice and expert opinion to aid clinicians in the goal of achieving best practices for primary and secondary prevention. However, these guidelines provide limited guidance on how to prioritize based on the individual. The Agency for Health Care Policy and Research have long recognized the need to increase education and quality improvement methods. Effective tools to prioritize the multiple CPG recommendations are still needed. Our central hypothesis is that the individual’s risk factor profile can provide the basis for adaptive personalized care planning for primary and secondary PrI prevention based on CPG prioritization.
The study design comprises a retrospective national database chart review combined with an observational study. The Spinal Cord Injury Pressure Ulcer and Deep tissue injury (SCIPUD+) Resource leverages the wealth of information from thousands of Veterans with SCI together with together with our established non-invasive methodology for tissue health assessment -THEToolbox (Tissue Health Evaluation Toolbox). PrI development, the primary outcome of interest, is related to over 75 multidomain risk factors. Factors for the SCIPUD+ environmental, social and clinical domains are derived by retrospective chart review of more than 400,000 encounters with a cohort of over 22,000 individual Veterans with SCI. Factors for the SCIPUD+ tissue health domain are determined by tissue health assessments of Veterans with SCI of more than 12 months’ duration.
A query based on the Elixhauser Comorbidity index found the most common comorbidity is depression in the study database cohort. Relational analysis of this cohort indicates depression occurs concurrently with many other risk factors. A multiple correspondence analysis on the sub-cohort who also had tissue health status evaluated revealed significant factors in multiple domains may increase or decrease propensity for recurrent PrI. For example, in the social domain having an associate’s degree decreased PrI propensity as did being married, while having a high school education and living alone increased PrI propensity.
The development of a healthcare tool for personalized, proactive, patient-driven PrI management in SCI will support identification and validation of best practices in SCI care, specifically primary and secondary PrI prevention. SCIPUD+ has the potential to enable personalized application of CPG priorities tailored to the needs of each at-risk person with SCI. SCIPUD+ will allow clinicians to develop effective personalized care plans for primary and secondary PrI prevention for individuals in their care.
Department of Defense Spinal Cord Injury Research Program W81XWH-15-1-0342
You Must Be Logged In
This Reminders tab will display for your scheduled lectures 15 minutes before start time and for new messages waiting.