Dr. John Steinberg, DPM, Co-Director of the Center for Wound Healing and Professor of Plastic Surgery at Georgetown University School of Medicine.For many years, we in wound care research were looking for a ‘silver bullet’ to heal a chronic wound. Today, with our enhanced understanding of the etiology of chronic wounds, we understand that both the formation of a wound and the healing of a wound healing rely on many different systems and functions. When we approach a wound recognizing its etiology and approaching it from a mechanical and functional perspective, we realize there is no magic gel or silver bullet. Chronic wounds aren’t a ‘podiatry problem’ or ‘vascular problem.’ Just as we need multi-disciplinary teams to treat wounds, we also can’t expect to address one element of a nonhealing wound and have the wound heal. The ‘silver bullet’ of today is no longer an individual product or technology, it is the combination of interventions, deployed at the right time to the right patient in the right kind of wound. Looking ahead, the “silver bullet” of tomorrow will be the information and insights we can pull from big data and patient registries to further refine and improve wound care practice.
Patient registries hold much promise in the utility they can deliver. Practitioners in the wound care space generally share frustration with randomized controlled trials that go to great lengths to standardize wounds and standardize wound patients. The result is that the patients enrolled in clinical trials bear little resemblance to the patients we treat. In wound healing, we need something that is more big-data based and real-world outcomes based.
The Promise of Patient Registries to Inform CareWe gain more insights from the shared experiences of fellow clinicians rather then crunched numbers of the unrealistic patient population in clinical trials. Today, we in the wound community realize the benefit of sharing our own data and experience. Forming and participating in registries is now a top agenda item for so many institutions. Registries collect and consolidate the data from real-world patients and real-world clinical care. With the help of registries, we can see what is working, in what environment, and in what patient population.
We can stop looking for a ‘silver bullet’ miracle treatment and instead apply real-world findings to real-world patients.My hope is that real world registry data can ultimately help us develop objective scoring systems to drive wound care interventions moving forward. For example, registry data could help guide decision-making about interventions for a patient who shows up at an emergency department with a badly infected diabetic foot. We don’t want to do procedures that won’t work. We do want to provide interventions that have the highest likelihood of success. We want to more quickly address when amputation may be unavoidable and the best path forward. Scoring systems generated with registry data can help guide this decision-making. Some wound providers today see 30 diabetic foot ulcers a day, some only two. A patients outcomes can be based on where they go for care. Registries and big data will help in the standardization of wound care practice.
We can improve outcome by creating validated scoring systems based on hundreds of thousands of patients. We can look at comparative efficacy. We can gain insights into what types of interventions work best in what types of patients, in real world practice. Registries can enable these strides forward. This is good for providers, health systems and payers. Most of all, it is good for the patients we treat whose pain and discomfort can be reduced and whose wounds can heal quicker.