Toward Personalized Pressure Ulcer Care Planning: Development of a Bioinformatics System for Individualized Prioritization of Clinical Practice Guideline
Abstract
Ultimate Applicability of the Proposed Research: Development of a pressure ulcer (PU) or deep tissue injury (DTI) after suffering a spinal cord injury (SCI) has devastating impacts on overall health and quality of life for too many people. There are known to be over 200 risk factors for PU/DTI development, which arise from many areas, from the environment where a person lives to the blood flow in the buttock region when seated in the wheelchair. Primary prevention seeks to prevent the initial development of PU/DTI, while secondary prevention seeks to decrease chronic recurrence for the individual. Clinical practice guidelines (CPG) combine evidence-based practice and expert opinion to aid clinicians in the goal of achieving best practices for primary and secondary prevention. However, these guidelines provide limited guidance on how to prioritize based on the individual. The proposed research will develop and test the Spinal Cord Injury Pressure Ulcer and Deep tissue injury (SCIPUD+) Resource, a multivariate structural model incorporating the many areas where risk factors occur associated with primary and secondary PU/DTI prevention, ranging from the individual s environment to local tissue health. This will provide clinicians with a tool for developing care plans that apply best practices and CPG interventions prioritized for the individual. The development of a tool for personalized, proactive, patient-driven healthcare will support identification and validation of best practices in SCI care for musculoskeletal health and rehabilitation interventions, specifically primary and secondary PU/DTI prevention. Ultimately, this research will be applicable to everyone with SCI and could enhance both personal health status and quality of life while reducing healthcare costs. Types of Patients This Research Will Help, and How It Will Help Them: This research will help everyone who experiences a spinal cord injury, especially active duty military and Veterans. There are multiple benefits, from the personal to societal, to providing PU/DTI preventive care tailored to the individual. By providing personalized primary and secondary care planning, the most appropriate interventions can be selected, proactive personalized education can be provided, and the insidious cycle of PU/DTI recurrence can be minimized. Potential Clinical Applications, Benefits, and Risks of This Research: The SCIPUD+ Resource healthcare tool has the potential to lead to care system changes for PU/DTI prevention. Development and application of the SCIPUD+ Resource tool will enable clinicians to develop personalized clinical care plans for primary and secondary PU/DTI prevention, including the most appropriate pressure relief regimes, lifestyle changes, and selection of support surfaces. The SCIPUD+ Resource healthcare tool will be applied to reduce PU/DTI incidence, benefiting everyone with SCI and providing a foundation to maintain an optimal quality of active life at all times following injury. Successful advancement of best practices for personalized PU/DTI management based on individually relevant prioritization of CPG will decrease treatment costs and improve quality of life for everyone with SCI. The development of PU or DTI can occur at any time following injury and remains a significant complication for many individuals with SCI. The primary risk of a personalized SCIPUD+ care plan is that the PU/DTI may still occur. We have defined a 50% reduction in PU incidence as being clinically meaningful; however, for the individual, any PU/DTI development is significant. We will monitor all incidences of tissue compromise or breakdown and apply iterative model development and/or interventions throughout the study, producing progressive refinement of the SCIPUD+ Resource during the study period. Projected Time to Achieve a Patient-Related Outcome: PU/DTI prevention remains challenging. Our research team has experience with all the t
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Apr 04, 2016
- Source ID
- W81XWH1510342
Entities
People
- Katherine Bogie
Organizations
- Louis Stokes Cleveland VA Medical Center
- United States Army