Approximately 30% of venous leg ulcers (VLUs) fail to respond to evidence-based treatments and remain unhealed; while after healing, 60–70% of ulcers recur. Currently most clinicians use only their experience to identify patients with VLUs at high risk of failure to heal or recurrence after healing.
To address this problem objectively, this project team has developed and validated two risk assessment tools to identify patients at high risk of failure to heal or ulcer recurrence. A prospective, multi-site study has demonstrated good predictive ability for both these tools (AUC 0.81, 95% 0.73-0.88, p<0.001; and AUC 0.83, 95% CI 0.68-0.93, p<0.001 respectively) with good inter-rater reliability for the delayed healing tool (ICC 0.84, 95% confidence interval (CI) 0.70-0.92, p<0.001) and the recurrence tool (ICC 0.88, 95% CI 0.75-0.94, p<0.001). The development and reliability results of these risk assessment tools meet the recommendations for evidence-based, reliable tools and may benefit clinicians and patients in the management of VLUs.
The aim of this project is:
- to evaluate the impact of the implementation of a pathway of care including new Risk Assessment Tools (RATs) developed for people with VLUs:
- on early identification and personalised management of those at risk of delayed healing and/or ulcer recurrence
- healing and recurrence rates
- cost effectiveness of care.
An expanded pathway of care for VLUs will be developed, incorporating use of the Risk Assessment Tools and their outcomes, based on current evidence-based guidelines and consultation with an expert advisory group.
The changes to current clinical pathways will be:
- to include a risk assessment using the RATs on the first visit (or healing for the recurrence RAT)
- to document risk status and the areas of risk identified
- along with subsequent management plan, and/or,
- referrals according to the level of risk identified by the tools.
Patients in the intervention groups will be:
- monitored according to the new expanded care pathways.
Education will be provided for all intervention site staff on use of the RATs and protocols.
Project outcomes will provide much needed information to guide clinical care and research for people with VLUs in regard to healing and recurrence.
Skills and experience
A background in health or related disciplines is highly regarded.
Contact Associate Professor Christina Parker for more information.