DOMINATE Wounds
A final and extremely important point to include in the DOMINATE Wounds concept is E-education. Lack of patient compliance is often the reason wounds fail to heal. This is especially true in the case of edema management, wound offloading, and diabetic blood sugar control. Compression stockings can be burdensome but are essential, off-loading footware may be cumbersome but often is absolutely necessary, and blood sugars consistently above 200 mg represent a significant impediment to wound healing (C. Attinger, MD, oral communication, March 2013). Therefore, it makes sense to prioritize patient education regarding the DOMINATE concept. If patients understand the value of the DOMINATE components with respect to their wounds and receive constant reminders, compliance and healing rates should increase.
As health care systems become subject to increasing oversight, and health care dollars become rationed, wound centers will need to demonstrate the cost-effectiveness of wound healing as a requirement for reimbursement. The challenges for such demonstration include the lack of defined outcomes for treating uncommon wounds and the absence of guidelines for managing patient behavioral issues such as compliance, or mental health conditions. Future research is needed to address these concerns. In the meantime, having a practical, standard approach to wound care that is consistent, effective, and supported by evidence can only help when wound centers are audited. The use of DOMINATE provides such an approach.
Conclusion
A final and extremely important point to include in the DOMINATE Wounds concept is E-education. Lack of patient compliance is often the reason wounds fail to heal. This is especially true in the case of edema management, wound offloading, and diabetic blood sugar control. Compression stockings can be burdensome but are essential, off-loading footware may be cumbersome but often is absolutely necessary, and blood sugars consistently above 200 mg represent a significant impediment to wound healing (C. Attinger, MD, oral communication, March 2013). Therefore, it makes sense to prioritize patient education regarding the DOMINATE concept. If patients understand the value of the DOMINATE components with respect to their wounds and receive constant reminders, compliance and healing rates should increase.
As health care systems become subject to increasing oversight, and health care dollars become rationed, wound centers will need to demonstrate the cost-effectiveness of wound healing as a requirement for reimbursement. The challenges for such demonstration include the lack of defined outcomes for treating uncommon wounds and the absence of guidelines for managing patient behavioral issues such as compliance, or mental health conditions. Future research is needed to address these concerns. In the meantime, having a practical, standard approach to wound care that is consistent, effective, and supported by evidence can only help when wound centers are audited. The use of DOMINATE provides such an approach.
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