STRATEGIES FOR DATA COLLECTION AND CLINICAL IMPROVEMENT

Programs and clinicians can leverage existing strategies for data collection and subsequent application towards clinical improvement. Some strategies include ensuring standardized clinical documentation, use of routine risk assessment tools, incident reporting and adverse event tracking, and benchmarking and performance dashboards.[5]

1. Standardized Clinical Documentation

Implementing structured and standardized documentation within the Electronic Health Record (EHR) is recommended.[6] This approach enhances the quality of clinical notes, making them clearer, more complete, and concise compared to unstructured documentation. In addition, standardized and structured notes facilitate data reuse for essential activities such as benchmarking, outcome monitoring, and comprehensive analysis.[6]

Utilization of structured wound assessments and validated severity tools leads to consistent documentation that allows for accurate measurement of incidence/prevalence and reliable longitudinal tracking of patient progress.[1][4] See topics "Pressure Ulcers/Injuries - Classification/Staging" and "Diabetic Foot Ulcers - Classification Systems".

Structured documentation is also essential for meeting regulatory requirements and accurately reporting on quality measures. Many Centers for Medicare and Medicaid Services (CMS) Value-Based Programs (e.g. Hospital Readmission Reduction Program (HRRP), Hospital Acquired Conditions (HAC) Reduction Program, etc) and Merit-Based Incentive Payment System (MIPS) rely on standardized data fields to calculate institutional or individual performance. By ensuring that critical data points are consistently captured through structured documentation, organizations can streamline the reporting process, minimize manual abstraction errors, and accurately demonstrate adherence to quality standards and best practices.[7]

2. Routine Risk Assessments

Improved risk prediction enhances quality by allowing for early intervention, which can prevent a chronic wound from worsening or help in developing a personalized treatment plan. This leads to better patient outcomes, such as faster healing, reduced complications like infection or amputation, and a higher quality of life. [8]

Risk assessments should be completed on intake and repeated at meaningful clinical intervals to stratify patients and guide prevention plans. Regular reassessment is important - risk fluctuates with clinical condition and other factors such as mobility, and nutritional status.[1][4]

Examples of risk assessments commonly used in wound care and hyperbaric medicine programs include:

• Pressure injury risk (e.g., Braden Scale): validated risk assessment tools such as the Braden Scale, Waterlow Scale, the Norton Scale help predict pressure injury risk and prevent development of new wounds. [2][9] See validated risk assessment tools in the ‘Structured Risk Assessment’ section of topic, “Pressure Ulcers/Injuries - Prevention”.
• Nutritional risk assessment: see topic, “How to Screen, Assess and Manage Nutrition in Patients with Wounds”.
• Diabetic neuropathy/diabetic foot ulcer risk: see topic, 'Clinician Guide for the Diabetic Foot Exam' and the '60-Second Screen For The Diabetic Foot' in topic "Diabetic Foot Ulcer - Prevention".
• Hyperbaric oxygen therapy (HBOT) safety risk: the Safety Committee of the Undersea and Hyperbaric Medical Society recommends that a Safety Time Out/Pause (STOP) be performed prior to the start of every hyperbaric treatment. A STOP should be completed regardless of multiplace or monoplace operations. A STOP will be performed in order to be compliant with safety goals, to combat complacency, and document completion of our unique safety practices. We recommend that the STOP be modeled after the timeouts performed before surgical procedures.[10] See topics, “Prohibited Item Risk Assessment” and “Safety Time Out/Pause (STOP) Checklist”.

3. Incident Reporting and Adverse Event Tracking

An Incident Reporting System (IRS) is a vital organizational tool designed to identify, report, document, investigate, and facilitate learning from incidents. In the context of health service delivery, the IRS is essential for quickly managing and addressing any occurrences that have caused, or have the potential to cause, harm to patients. By systematically reporting these events, hospitals can learn from them, leading to system improvements that ultimately ensure greater patient safety. [11]

Incident reports are often used to document HBOT adverse events and program amputation rates related to diabetic foot ulcers (DFU).  Amputation rate in DFU patients is a sensitive quality measure and correlates with gaps in screening, offloading, and infection management. [4]

4. Benchmarking and Performance Dashboards

International guidelines endorse benchmarking against internal standards and external best practices, including balanced scorecard models integrating safety, effectiveness, efficiency, and patient experience.[1][3] For details, refer to topic “Applying the Balanced Scorecard in Wound Management and Hyperbaric Medicine”.

Performance indicators that some programs utilize to assess the quality of wound care include [12][13][14][15]:

• Time for a wound to heal
• Facility-acquired pressure injury incidence
• Hospital readmissions for wound complications
• Amputation rates among DFU patients

 5. Applying the Data: Plan–Do–Study–Act (PDSA)

The PDSA is a quality improvement framework that is used to test interventions efficiently and that operationalizes data into actionable improvement. PDSA cycles have demonstrated reductions in hospital-acquired pressure injuries when interventions are tied to incidence monitoring and staff education.[16][17]

The PDSA concept involves structured, iterative tests of change involving the following phases [16]:

• Plan: Identify a problem using trend data (e.g., increasing heel pressure injuries. Define a measurable goal and intervention strategy.
• Do: Implement interventions in a defined unit or timeframe.
• Study: Measure change using the same metrics used to identify the issue.
• Act: Adjust interventions, scale success, and update policies.

TECHNOLOGY IN HEALTHCARE DATA ANALYTICS

A healthcare future that is linked to data offers immense potential to transform patient care through data analytics. As technology continues its rapid advancement, applications such as the ones listed below continue to evolve:

Artificial Intelligence (AI) and Machine Learning (ML)

• AI-powered algorithms can analyze vast healthcare datasets in real-time, leading to faster and more accurate diagnoses.
• ML models can uncover patterns that human analysts might miss, generating new insights into disease prevention and treatment.
• AI can contribute to a more equitable healthcare system, such as by supplementing ophthalmologist expertise with eye health information derived from image analysis.

Precision Medicine

• As more data on genetic and environmental factors becomes available, data analytics will be crucial in developing personalized treatment plans tailored to each patient’s unique characteristics.

Telemedicine and Remote Monitoring

• The expansion of telemedicine and wearable devices is creating continuous, real-time streams of health data.
• Data analytics will allow providers to monitor patients remotely, detecting early signs of health issues and enabling timely intervention before they become severe.

Population Health Management

• Data analytics will continue to be instrumental in identifying health trends and disparities across populations.
• This capability allows healthcare organizations to implement targeted interventions and ultimately improve health outcomes for entire communities.

Integrating data analytics into healthcare promises to revolutionize patient care, making it more proactive, personalized, and efficient. As healthcare systems increasingly rely on data-driven insights, the influence of data analytics in shaping the future of patient care is set to grow significantly.