WOUND INTERDISCIPLINARY TEAMS (WIT): A COMMUNITY-BASED PRAGMATIC RANDOMIZED CONTROLLED TRIAL

Purpose: With the increasing prevalence, complexity and cost of chronic wounds, there is pressing need to improve community-based wound care services. The purpose of Wound Interdisciplinary Team (WIT) study was to evaluate the effectiveness and cost-effectiveness of systematic referral to specialized multidisciplinary wound care teams (MDWCTs) for community-based patients with chronic wounds in Ontario. We report the results of the randomized trial here focusing on the effectiveness analysis.

Method:

The Wound Interdisciplinary Team (WIT) study was a pragmatic community-based randomized controlled trial from May 2011 to May 2013.  Adult patients newly referred to Toronto Central Community Care Access Centre (CCAC) for wound care were screened for eligibility. Patients were stratified into four wound groups (pressure ulcers, diabetic lower leg ulcers, non-diabetic lower leg ulcers and others) and two service types (outpatient clinics and in-home service). The control arm received the standard of care currently delivered to community-based patients with chronic wounds. The intervention arm received, in addition, a comprehensive clinical assessment and wound care delivered by nurses with additional wound care training. Patients meeting referral criteria were systematically referred to the MDWCTs. Patients remained in the study until their wounds healed or for a maximum of six months. Patients whose wounds closed within six months were followed up for an additional six months to track wound recurrence. 

   The effect of the intervention on a) time to wound closure (primary outcome); b) time to discharge from CCAC; c) monthly wound size reduction; and d) recurrence of healed wounds, was investigated using Log-Logistic Accelerated Failure time models, Cox Proportional Hazard models, Linear Mixed effects longitudinal models and Logistic Regression analysis respectively.

Result: 484 wounds (Control=234, Intervention=250) belonging to 397 patients (Control=193, Intervention=204) were included in the analysis. No significant effect of the intervention was found on  a) time to wound closure (Incidence odds ratio = 0.95, 95%CI= (0.67, 1.35), p-value = 0.77);  b) time to CCAC discharge (HR = 0.85, 95%CI = (0.66, 1.08), p-value=0.18);  c) rate of healing (difference over time=0.27cm2/month, 95%CI = (-0.31, 0.84)); and d) recurrence (OR = 0.72, 95%CI = (0.31, 1.65), p-value=0.44).

Conclusion: Systematic referral to MDWCTs did not appear to be effective. Contextual factors and factors related to study design may have limited our power to detect a treatment effect.