Leg-ulcer care in the community, before and after implementation of an evidence-based service

CMAJ. 2005 May 24;172(11):1447-52. doi: 10.1503/cmaj.1041441.


Background: Leg ulcers usually occur in older patients, a growing population for which increasing health care resources are required. Treatment is mainly provided in patients' homes; however, patients often receive poorly integrated services in multiple settings. We report the results of a prospective study of a community-based care strategy for leg ulcers.

Methods: International practice recommendations and guidelines were adapted to make a new clinical protocol. The new model, for a dedicated service staffed by specially trained registered nurses, established initial and ongoing assessment time frames and provided enhanced linkages to medical specialists. Data were collected for 1 year before and after implementation; outcome measures included 3-month healing rates, quality of life and resource usage.

Results: Three-month healing rates more than doubled between the year before implementation (23% [18/78]) and the year afterward (56% [100/180]). The number of nursing visits per case declined, from a median of 37 to 25 (p = 0.041); the median supply cost per case was reduced from 1923 dollars to 406 dollars (p = 0.005).

Interpretation: Reorganization of care for people with leg ulcers was associated with improved healing and a more efficient use of nursing visits.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Delivery of Health Care, Integrated
  • Disease Management*
  • Evidence-Based Medicine*
  • Guideline Adherence*
  • Health Resources / statistics & numerical data
  • Home Care Services / organization & administration*
  • Humans
  • Leg Ulcer / therapy*
  • Prospective Studies
  • Quality of Life