During this webinar, the presenter will review the benefits of early initiation of V.A.C.® Therapy and its impact on wound surface area reduction across multiple care settings.
Good morning and welcome to today's Webinar the impact of early initiation of back therapy. My name is Aaron McClure, and I'm a medical education manager with three M. So let's begin today by introducing our speaker, Cindy Miller. Mika watch it, who has been a registered nurse since 1978. In 1992 she joined Casey. I is a clinical consultant and has been a leader in negative pressure wound therapy since back therapy, launched its 1995 with her new role as the global medical translational lead for three m. Cindy leads and supports medical and clinical strategic insight for advanced wound care as well as the negative pressure wound therapy portfolios, from development to commercialization. Cindy's passions for patients and solutions are drivers for her superior education. So at this time, I'm gonna test the pecan over to Cindy and thank you. Thank you so much. Erin and I want to thank every single person from across the globe who's joined us for this very important talk. Today. We're facing unprecedented problems, as we all are aware in each country. Of course, that's joined us today. You're in a different phase of your response to the coded crisis that's been going on. So it's a time of great uncertainty. And one of the things we want to lean into is evidence based medicine, of course, as well as transformative solutions. And three M is one of the most trusted, uh, companies that you can lean into for evidence based medicine. So we're going to talk about some of the things today that we're facing. And even though the data that I'm going to show you and I'm the senior author on the data, I'm going to show you, um is that we are I think most of us, whatever country you come from, from the UK or maybe you're from Germany or Switzerland or even over in China. Japan, Uh, we're trying to doom or without seeing the patients in person as much due to all of the transmission issues. So we I think, here in the US, for sure I can't speak to your particular country are clinicians are being encouraged to minimize the number of possible admissions and procedures and decrease the length of stay. And we're managing ah lot of the patients through telehealth and to reduce visits, so you may actually have, as I'm sure you've encountered reduced visibility. Maybe the patient themselves doesn't want to come in. And you know that. Typical. You need to do a did Dr Menard agreement, um, for that wound. And maybe it comes in in a critical mass instead of giving it normal care. So these patients, sometimes we're seeing here, have gotten off track. So to use proven treatment modalities, to look into some of the more assertive technologies to help you manage your patients is I don't think there's ever been a more important than it is now. So the product that these, um, data pull that we're going to talk about it was from an EMR was focused on active act. Now this is our portable unit. I think it's available throughout Thea outside of the United States. Or, if you hear me call it Oh, us. That means outside the United States. I think that's available in almost every country, if not all of them. The one on the right is a mechanically powered disposable negative pressure device called Snap. You may not have that available in your country, but you probably do have one of our other disposable negative pressure devices available to you. So whether it's a piece of durable medical equipment that's picked up and cleaned after the patients done with it or disposable, both of these products are phone based, and the product that was looked at in this data that I'll be reviewing was phone based active act therapy for the most part, from K C. I at the time and now three m. So one of the things that's interesting when we look at what's driving value based care decisions. And I've heard that over there in the N i H NHS um, they are looking at a value based procurement project. They're getting ready toe. Look at eso the price of an item. The line item cost puts the product on the shelf. It puts it in your hands for you to use, but the value comes. The value of that product comes by using it on the right patient for the right period of time. And this what you see in front of you decide in front of you in this. Pdf is available to you to download. Is Erin mentioned before? If you can download before the end of the presentation, maybe during the Q and A. But this is interesting is a retrospective analysis that was conducted on a national insurance providers medical claims data. I'm gonna step back for a minute. For those of you that have honored us by joining us from outside of the United States, there's some basic reimbursement things that you may or may not be aware of. So I'm going to do a brief overview. We do have what's called C. M s, which is the Center for Medicaid and Medicare services. That's our federal and state run insurance plan for health care. Then we have commercial carriers, private insurance, if you will this. And that's where if you're employed by a company you're employed by a hospital, you can access their private insurance and pay a fee for that. So this retrospective analysis was done with one of those commercial or private insurance providers medical claims data, meaning what they actually paid out. So this is gonna lean into the value. What are they paying for? The patient's care versus is the price of using back therapy was a pretty large in 6181 acute and 1480 chronic wound patients that received MP wt between January 1st 2009 and June 30th, 2011. So about a little bit over 2.5 year span and what they looked at when they looked at what they paid out. The cost of caring for these patients that have these wounds showed that early initiation of negative pressure wound therapy resulted in lower estimated total and wound related costs, then late initiation. So that's really interesting, because that's the topic of what we're going to talk about today. And these wound related costs, when you look at it were 41% lower for chronic wounds that were treated early with back therapy versus late and you can see the number in U. S. Dollars, they're based on the claims that they paid out with an interesting P value less than 0.1 It was 30% lower for the acute wounds that were treated early versus late on. That's one theme that you're going to see throughout this presentation. You're going to see that it's not. Did they get back therapy? It's did the timing of when back therapy was started. Make a difference. So we all know that there's a lot of wounds that don't need back therapy that can be treated with advanced forced, wound healing products. And then we have those wounds that we typically we look at 61 I think that one might need back therapy. Do I start it now, or do I wait and started later? And so in this data set that they looked at with a large in it indicated there spend from the insurance. This point of view was less when the physicians chose to use back therapy early versus late and what's interesting when they look at those were the wound related costs. Now let's look at the total cost patients with chronic wounds. So this is everything, not just those costs that they pulled out from the claims data that were related to the wound but total cost of care. The chronic wounds that were treated early at 25% lower estimated costs and those that received back therapy later, and with acute wounds it was almost 18% and both of those were also statistically significant. So that's not the topic of what we're going to discuss in detail today, but I wanted you to be able to look at when you, if you are looking at value based projects, procurement projects. If you are involved here in the United States, if you are involved in trying to deliver superior clinical outcomes at the lowest total cost of care, that's something that we want to at least know in any of these studies. If they're not already attached in Europe files, we can certainly get those to you afterwards if you reach out to your local or country representative. So so here's let's actually get into today's data and what we want to talk about. We know you have a lot of choices. We're going to talk today, Um, in the wound care choice of all the things you have in your in your office or in your clinic or in the hospital. Is there a difference where the actual title this early use of Casey it was Casey at the time. It's now three m vac therapy and retrospective Davis demonstrated wound surface area reduction. Now that's probably not much of a surprise, because when you do choose back therapy, you're choosing it because you do want that wound smaller, whether you're going to use that up to surface or whether you're trying to do some wound bed prep. You're looking at the time principle. You're wanting to maybe bring them back in for some sort of surgical closure. Or in this crisis that we're facing now with no bid, it might be that you're trying to at least get that wound to a small enough size that your staff, if they're seeing them in the home or they're seeing them somewhere outside of the hospital, can be managed more easily. So really, and I think there's some ongoing changes outside of the US There have been a lot of changes, and it really does. We feel further elevate the value of early initiation back therapy across many care settings, and I'll show you some of the other data on these other care settings. We know you have many options available for management wounds. We do believe that there's been a fits of early use of AC therapy and that has been shown in multiple settings, and these references are on the pdf, and you can get those from your your local rep if you want them. I already showed you one from a payer. The private insurance point of view that showed early use made a difference to them financially. But we know that when you look at that patient and you're evaluating them, they're wanting to balance the cost of that. Individuals treatments what you're choosing to do with the over overall cost of care, because there's an ongoing endeavor in many settings, including the wound care center, the balance and a wound care center or wound care clinic. For those of you that are outside of the United States, are typically affiliated with an acute care hospital. They have a clinic that's, um, some or close to the hospital like maybe where the doctor's offices are and they are able to build the appropriate insurance provider, whether that's the federal government here in the States Medicaid program or the private insurance, and they can get that patient out of the hospital and then care for them in this outpatient clinic. So we call it a wound care center or a wound care clinic. We also have home health nurses visiting nurses that go into the home and so you might hear me call that H H, a home health agency, but for the wound care center. They just recently undergone quite a large change in their reimbursement structure here in the United States, where they need to deliver, as as we always have ethically in our hearts, as clinicians wanted to deliver superior clinical outcomes. But they have to balance that now more than ever, with the total cost of care. And we do know we're definitely here in the US, moving towards that value based care model. And as I mentioned earlier, I hear there's a project going on at the NHS for that as well. So these other care settings, as as I mentioned earlier today, when we get to the data just a slider, so we'll talk about the wound care clinics or wound care centers thes outpatient settings. But here's some other previously published data That's really interesting. We know that as as Erin mentioned was launched in 1995 it actually was launched in Europe first before it ever was FDA cleared here in the United States away to go Europe for being a leader on that, so it's been successful managing wounds for over 20 years and the benefits of early back initiation not do they get it or not? But when when does the clinician choose to start administering it? So that's been actually evaluated in other care settings on keeping Confluence. All of these have been here us centric, um, in both acute care, long term acute care. What is long term acute care? It's sort of the in between is a hospital. It's a long term acute care hospital. We call them L Tax. We shorten it. Used the initials, Um, but it's sort of they're not. They don't really need to stay in the acute care facility, but they're not quite ready for a nursing home or going into back to their own home. So these let's talk about these four studies. I won't go into a lot of detail. They're all available to if you'd like to read them. But Dr Kaplan is a trauma surgeon in Philadelphia, and he wanted to see if the timing of initiation that therapy made a difference in his traumatic injuries. So he looked at early being defined as within the first two days. Early initiation back therapy was it started within 48 hours of the icy admission, and late was any time after that and what he reported. And let's look over that very first bullet. He reported a reduced inpatient days in both the acute care overall length of stay as well as in the intensive care unit by at least 50%. A really interesting article. If you want to delve into that, if most of your practices in the acute care world or you deal with traumatic injuries, then there's a couple of interesting things by Dr Driver and Dr Daily in in that long term acute care hospital setting on both pressure ulcers and surgical wounds. Those air two very common types of wounds for patients that were discharged from the acute care hospital to the long term acute care facility. And what they reported was that there were reduced inpatient days in that long term acute care setting by 30%. This is nice because when we're trying to get our patients into the home back to that home setting, that was a very interesting and once again it's not. Did they get back therapy for these worlds? It's When did they started? Did they started early versus late. Now they had a different definition because this was a long term care facility. And long term in this reimbursement setting typically means 30 days or less. So it's not like months and months and months or years where you might see that in the home with the visiting nurse. Or they might be taken care of at one of the outpatient clinics. So they used the definition of early initiation was within the for the acute wounds was within the first seven days and earlier initiation for the pressure. Ulcers and chronic wounds were within the 1st 30 days. So when we move over and and I know this is probably intriguing, you and you'd like to look at those articles, they'll be in English. But we can get those for you. Then Dr Behar Stanny did a sequential. She did two different studies, and what she looked at was in that visiting nurse environment. In the home care environment, she looked at surgical wounds that might be your hiss surgeon. Three hissed incision that might be a Pilon idol, um, cysts that you've, you know, excised. But she looked at the surgical wounds And in that surgical wound, uh, world. Seven days was earlier than the first seven days, and after seven days was late. Same thing with her home care pressure ulcers, but the definition that these were the stage threes and fours. Here in the United States, we do not treat used back therapy for our stage to share the more surface pressure. Also, it is reserved based on reimbursement for stage threes and fours. Her definition for these more chronic pressure ulcers was within the 1st 30 days was early and after 30 days was like. And if we look at the last two bullets to the right for those surgical wounds, the reduced home care length of stay meaning needing toe have a visiting nurse come in to care for that wound. If that therapy was started early, it reduced that time that they needed the nurse to visit them by 34% for the surgical wounds and the home care link. To stay for the pressure, ulcers was reduced by almost half. Very interesting. I think it surprises. It surprised us as we started to see these papers come out that even the timing of back therapy made a difference versus having the patient language for a long period of time before instituting back therapy. These data reflect the possibility that there was a significant difference and and the parameters that he's authors tested. I think quite clear that the majority of you feel that moving these wounds towards a rapid reduction in size has a wide variety of clinical benefits. So and I actually values significantly the neutrals and the not very important, because there are certainly times that we just maybe they're in some sort of hospice environment or end of life, Um, that that that's not very important for that particular patient. So I truly honor that dies and let's start to delve into the data set that is the subject of today's talk. I wanted to lay that background there for you so that we could move into this. And I think this might be particularly important for Germany if those of you is is of course really important for the U. S. Because this is where the data came from. But Germany, I think, a round of applause to Germany for receiving reinforcement in the out of hospital setting. So in the home setting. I don't know all the details about that, but congrats to Germany. I think that's fantastic. So this was us centric. It was pulled on. This analysis had a large in. It examined 4739 patients. Excuse me, wounds in 3604 patients. So clearly quite a few of the patients had more than one wound, which is, I think we see that in our practice. When we looked at the split of the patients that were part of this data pull, it was 56.7% of them were categorized as being a cute wounds That could be a traumatic injury. A surgical DigiScents, a surgically created wounds such as a Pilon Idol, excision or maybe a hematoma. And 43.3% of those were classified as chronic ones. And those would be are sort of standard ones that we would think of the lifestyle related. I have Venus problems, Hypertension, Venus like ulcers. I'm immobile pressure ulcers. I have arterial ulcers, all of those things that tend to cause these wounds to get into that chronic cascade. What I like really about this when we chose to do this data pulled, we looked at 56 wound care centers that were crossed tent that were across 10 states. And of course, most of you know from your geography classes there's 50 states in us, so it wasn't just in the Southwest or it wasn't just in one or two states. It was 10 states which really reduces, um, regional biases toe how practice happens, or particular physician practices where they might have sort of a routine. The date range was from 2000 November 2002 July 2010. So it was a wide span, and that sort of helped blunt down any sudden practice changes. And we pulled the data from the intelectual registry from The Woodlands, Texas. Now, I don't know if any of you have ever heard Dr Caroline fight speak at a wound care conference. She is amazing, and this e. M. R. Was developed by her and her team. And it's one of the electronic medical record options for these wound care clinics, or WCC s. And here in the United States, our federal government, the Centers for Medicare and Medicaid Services. CMS recognizes that this data set things pulled from this when they go in and they do, analysis is actually recognized by them is being valid. And not only that, the registry has been accepted by the U. S. FDA, Food and Drug Administration as a reliable source to evaluate the safety of negative pressure when therapy. Now, let's just in a full disclosure. This was, of course, retrospective. We went into the data and we pulled it out, and we evaluated riel world patients who were treated that these wound care clinics or wouldn't care centers these out of the hospital settings. And what's interesting about that? Of course, the gold standard. I mean, if you could get a meta analysis, that's amazing. But we do know that randomized control trials are considered the gold standard that we want to lean into the data. We want all practice evidence based medicine. But because of the inclusion and exclusion criteria that you have tohave with, these are CTS. You have to be able to tease out a lot of the variables so that when you look at your control versus study arm, you can see if their statistical significance, but and that's good and We want to always look at that data and lean into that. But here's what happens, of course, and I'm sure you see it every day. They'll exclude people with a hemoglobin, a one C over a certain amount, or they'll exclude them with a blood glucose over a certain amount. Or or that if the wound is infected, they may or may not be exc included from the RCT. When you go into your clinic, where your practice of the hospital or you're working in the E. R. On call, you have to take care of the real world patients. You have to take care of those that don't take care of their blood glucose, that they're poorly controlled diabetic, that they're hypertensive, that they're on anticoagulants or immuno suppressive. So this was a nice It's a nice way to sort of step back and say, OK, here's what they looked at. Here is over 3600 patients, riel world, and here there's a statement in the United States. Take all comers that you take whoever comes in the door and you have to care for them. So in this data pool, once we pulled all the data. We leverage the pre existing studies that were done based on defining what's the early initiation time frame and how are we going to define late use of negative pressure when therapy And at the point of this data pull about 98% of all these patients or the market share in the United States was a k C I product, the active act with sense attract technology. So just to make sure, even though it's a generic and P w t about 98% market share of the time. So in the acute wound category for the early use, we leaned into what Dr Daily in and Dr Driver used, and that was that the early use because, remember, this is Dr Katherine used two days, but that's the I C here. This is an out of hospital outside of the hospital care setting. So from the point of admission to the wound care center early was defined us within the first week. Within the first seven days of admission that gave the clinician a couple of visits to evaluate it. The wound to make a decision if back therapy was started after Day seven, that was tagged as a late initiation. When we look at and that would be your surgical, the distance, your traumatic injuries, maybe you're hematoma, evacuations, etcetera. The chronic wounds which were the pressure ulcers, venous leg ulcers. All of these other wounds that you would not be surprised are chronic. Um, that was expanded for early. That was it within the 1st 30 days. Now, part of that is here in the United States. If you're going to build, um, many of the private insurance companies but really our CMS, our Center for Medicare and Medicaid, the government run insurance program, if you will, they have a limitation. And if it's a wound in the outpatient center center, they want you to use the want the clinician to use an advance moist wound, healing products for 30 days and then have it fail. And then you could start back therapy. So that was part of the early use. Now we do have, ah, carve out where if the physician wants rapid, rapid granule ation which most of you voted, Yes, that's important. They can truncate that and make it shorter, But we wanted to have a standard then This also leaned into Dr Behar studies. Two studies in the home health environment where she defined chronic within the early was in the 1st 30 days, and late was after 30 days. So those were the definitions that we had pre defined prior to the data pool. Now what type of wounds were categorized? So when the nurse or the doctors filling out the electronic medical record at the end of the visit, um, these were the boxes that they could check? So that's a limitation of this study is that we didn't have you looked down at the chronic miscellaneous and pressure ulcers heels and not on heels. There was, So there were so many clinicians. There's some variability, of course, and there's There's certainly some further work that could be done here. But you can read that those wounds. I don't think there's a big surprise with any of these. Oh, and I haven't mentioned diabetic foot ulcers up till now, but that's one of the most frequent wounds I knew I was missing a chronic ulcer. Um, those air, some of our most challenging and I think with the really, really rapid increase with diabetes globally, especially here in the US We're seeing it a lot, Um, and all the downstream cascade of healing issues that happens with their micro and macro vascular disease with their hemoglobin, a one c and many times. Aziz. You know, there's a lot of problems if you have to do a major amputation. So here's the methods. The wound surface area. We did not measure volume. We measured wound surface area, which is the most common way in other studies that a wound is measured. Why? Because volume is hard because I have to add depth. There's still variability will lengthen with We all know that different people measure different ways. But volume is really hard to do because unless you do some sort of volume displacement measure, you've got one of the newer three D cameras. It's really accurate, and you've done enter rate of reliability testing on that. The depth is the most challenging one to be accurate on so length, times width or wound surface area was pulled from these visit records on each visit now, ideally, we would have left have had volume, but then you would have had to also document under mining and tunneling etcetera so it was length, times width. Not uncommon in wound healing studies this wound surface area, you'll see it listed in the second bullet as W. S, a short for wound surface area. These measurements were, of course, recorded for each visit. That's what they do when they come into the clinic as they recorded every single time they see them. And then every time they saw them, it was continued. And we stopped our data poll when the wounds had reached a reduction of 75% wounds surface area from the first visit. Why did we stop it? It's 75%. I think all of us will acknowledge that by the time the wound to 75% smaller than when you first saw it. The depth is probably also much more shallow. It's filled in from the bottom up, and it's extremely valuable, clinically and economically to at that point, step them down to an alternate product. Or maybe you're going to take them in and do a split thickness skin graft or, in today's structure, use of biologic. Or maybe you're going to just you've you've closed it in other ways and delayed primary closure rotated a flap, etcetera. So that's why we chose to stop it. 75% reduction and the date of initiation of negative pressure in therapy or back therapy was also reported from the date of the first visit. So let's say they came in to make it easy on July 1st, because that's today. By July 8th, seven days later, if back therapy had not been started, they bumped into the late category. Because remember, everything you're going to see here isn't Did I give them back or not? Did I order back or not? It's the timing of it. So everything is about this timing. Make a difference in reduction to wound surface area by 75%. So that's how they reported from the first day to visit, Not the first time they got the wound. The date the wound was You know, they acquired the wound because sometimes for the United States they don't make it into the wound care center till a while down the road after the wound. So this was what they could control. That was the date. First visit to the wound care clinic and then when back was in the Shavlik and Of course, the wounds were classified into the types listed on the left and in this presentation section in the previous slide, the woods, then we're sort of sub grouped into acute and chronic categories, as we mentioned earlier. And we applied the early versus late definitions I've already discussed with you. So now we're gonna park here on this slide for a bit of time. I want to make sure that we cover this. This is where the data resides. So let's focus. Don't look over the product. Don't look on the right yet look on the left and let's talk about the acute wounds. These acute ones, the wounds surface area linked times with it. These were the median days from the first visit to 75% wound surface, every reduction. So this is the early got to 75% reduction at 44 days median. And the late group was a little bit over twice that 81.6 days so that we were surprised. I mean, we knew the other care settings had had similar signaling, but to have 40 days versus 81 to get the 75% reduction was quite a surprise to Bobby James, who was a statistician who worked with me on this so you can see highly significant P value there and that those are the actual numbers and then the graph is down on the left. Now let's let's bump over to the chronic wounds category. These are the ones that can languish for a long time, so you can see that when they initiated back there through that, in the 1st 30 days of visiting the the wound care clinic they received, they reached 75% wound surface. Every reduction, 96.4 days versus 274.6 days, so also statistically significant and also quite surprising. And I tend to think of these things ah, lot of times in months. So if we're looking at three months vs a lot of months 12 into, that would be over two years now. These were Dave. Sorry. Yeah, three months versus 30 into that. So 10 months. That's a big difference for quality of life. To me, it was my body or my my dad who's 87. So when we talk about those of you, the 94% that felt it was either very important or important that you get a rapid reduction and wound size. And there's so many caveats, so many reasons why that's important. Whether that they're working adult or whether they're, you know, that they're the type of patient that tends step. Have problems with wound healing. This is a very interesting a couple of pieces of data here. So now I want to go back to our very first polling question, and I don't It wasn't a trick question, but I think we all over time because back there we just take a little bit longer to apply. And there's, you know, the alarms and canister changes and things. I think a lot of us in our critical thinking skills and our little algorithm that builds up in our brain over using, you know, we've been a wound, care for a period of time. I think we all develop patterns of when we treat with back therapy or not, and also patterns of when If I'm going to use back there, who do? I started early versus late, so no surprise there. That's the title of of this data quote. So the reason We did it. So now let's go back toe question one, which is I tend to use back therapy on my largest wounds. I think that is very common. And And your your agreement, I think there were 60 68% of you. Excuse me. Not 68. It was 66%. 66% of you either agreed or strongly. Agreed. I got jot it down in my notes. I'm going to sort of maybe surprise you a little bit here because I'm gonna pull away my little animation here for the acute wounds. We also we didn't just because you can have a very large to hiss surgical wound and a very large traumatic injury. You can have a small or you can have a small pilot novel or small hematoma evacuation, or you can have a big one. So we took each of these sizes from 0 to 100. What we did was to split them into four tiles, so we split them by 25% increments and sizes. So if we look at portal one, these were the smallest of the wounds by math for their wounds Surface area. If you were front, so that be from 1% to 25% of the measurements. If your wound was a little bit larger, 26% that 50% you landed in the poor child tuba. So these let's think of these is medium sized rooms for child three was from 51% up to 75%. That would be poor child three, the large wounds and then portrayal. Four. Think of those is the extra margins, the large wounds in their category and that would be court top four. So when we look at that and we look at that signaling So I've got a box around the all sizes and then each foretell actually, and I didn't put it on this side because it would have been so busy. But each of these were statistically significant, and the number of days that were quote I'm gonna put my fingers that make a little parentheses that were saved. The reduction in days to reach 75%. The message was consistent, no matter the size, and you might be thinking, Oh, my oh, my way can have ah pretty small diabetic foot ulcer or we can have a fairly large one. But no matter what size it was, if you were to think about, you know, because you could only have so large of a wound on the foot based on the size of shoes that they wear. But even within the diabetic foot category, there was consistent response that it did not matter if it was very small in this patient population in the state of coal. Now, for you to think about that and maybe roll that around in your brain and maybe challenge yourself, that's for you to decide. I just wanted to show you the data. So but Cindy that those air sometimes sort of easy those air, the acute ones, those are the ones that respond. Well, what about those Really challenging pressure ulcers? What about the diabetic foot wound? What about the Venus leg ulcer? Well, it might or might not surprise you. That was also Look at that. Look at those bar graphs. And if you want the full data, we can get that for use of the poster that this was published from, But it was really weak. Truly. I think Bobby James and I, the statistician, were internally biased as well, um, that we thought that it was going to be a much stronger signal and for child three and four than for child one and two. And that's why we do these types of studies. That's why we lean into data and that this was really world use. This was every single patient who walked into the wound care clinic who received back therapy those 3600 patients with over 4000 wounds. This is what they, um, resulted in. So when we I'll be happy to go back to this when we get to the Q and A if any of you have any questions, we'll be happy to talk about it in more depth. But this was another little angle, and it's just something that Chuan, of course, it's us centric eso those of you that air here in the United States. It's interesting to look at the proportion of wounds that received early initiation of compute deputy or back therapy in these wound care centers during this time frame. So for the acute wounds which I put in a pale lavender, these indications traumatic wounds and surgical wounds were started within the first seven days of admission. Um, and you could see the percent of wounds that actually received early initiation. So you can look at amputations, maybe 57% surgical wounds. Those would be more of your his surgical incision, things like that over close to 70%. So okay, that's great. That's probably it's definitely a reflection of the practice patterns at this time in these patients. And I also think it might not surprise ah lot of us that when we look at the chronic wounds, Venus leg ulcers will right at 40%. Pressure ulcers work. It wasn't started early, much more frequently than that, Remember, it's not. Did they get back at all? It's. Did they started earlier? Did they wait until after 30 days with these on you? You can look at the rest of these. So, based on these data, the wound care centers or wouldn't care clinics in this status that have an opportunity to potentially look at initiating back. There'd be earlier on all wound types because it wasn't they weren't choosing. Do I prescribe back or not? It's They all received back therapy just early, or like so I thought that was really an an interesting little side bar. So when we look at it in a different angle same data that I showed you two slides ago the results of this early initiation versus late when the back when back therapy was initiated early and the wound care clinic treatment time period compared to starting it late the days to reach significant closure 75% 1 surface, every reduction were half the time pretty cute wounds and one third of the time for the chronic wounds. Additionally, this improved wound surface area reduction was observed for all sizes of both the acute and chronic wounds with the early treatment. So this is just a review of that payer source. I have it in here twice, so I'm not going to review this again. This is from the medical claims data. But I think based on that previous polling question, we have to pay attention to the dollars, euros, pounds, whatever it is that your currency is where you live, we again we have to pay attention to that. But it hopefully if you're looking, at least from the US point of view from a private payer, the early initiation will not drain the budget. It will if it resonates it all. If it even half of it resonates over to your care. Setting might be a value certainly based on what we just looked at clinical value to getting the wound smaller rapidly, but it might parlay actually into financial things that are good as well. So when we look at the outcome from this patient population, I think my hope for you is that you just think through this that you take it and you ponder You know how we are. We'll be driving somewhere or maybe not driving. Maybe we're going from our bedroom to our office down the hallway with working out of our house for these days. But you might be thinking, Oh, you know, I wonder if I should have started this on on Mr Smith earlier, or do I have someone that I've been thinking about it? I need to consider starting it now versus waiting another week or two months. So the analysis we discussed supports previously published benefits of early initiation of back therapy that were reported in other care settings, and now that trend has been extended to these outpatient clinics In addition, improved one wound wound surface area reduction was observed for all sizes of the acute and chronic wounds. With that early initiation and as value based care models evolved, health care practitioners, physicians clinicians should consider earlier use of MP wt and their protocols to achieve the healing rate benefits in our opinion and based on the data that we just presented. So we I think we all agree we're in challenging times. And I hope you know that three AM provides more than just a product to you. We try to be a partner with you and whether that in service education are 24 7 around the clock support the on site and virtual rounding support that we have here in the United States. The clinically trained represents all those things. I won't read them all to you. But we have a great heart to help you, especially in these challenging times. And I hope you, uh you hear that from us and you hear our heart and feel our heart. So we have solutions. We don't just provide products, we provide solutions to you. And we'd like you to start thinking first time every time that management of your patient's wounds, it's not a time necessarily toe. Have them wait. So we've been around for 25 plus years. We this portfolio and I won't read all clearly. There's a lot of references here that will be available in your pdf that I hope you do download some of those handouts that available to you. But you'll see six bullets down there at the bottom, and one might be more important to you than others. And I encourage you to lean into the science, lean into the literature and continue to do the things that you're doing. I admire each and every one of you. It's never been more challenging to be a health care professional than today. So three m of these solutions that we try to bring to you They're all built on this foundation of innovative technology, service and support. I won't read the bullets to you. I I really dislike it personally when I'm at the end of the present time listening to someone I'm like, Okay, I can read it. I'm an adult, So they're here for you. But optimizing your outcomes. If you look at the third column, the very last one optimized the outcomes for you, but the patient's quality of life patient the patient's ability to feel encouraged and optimistic about their chance to get back to their normal activities of daily living. So I really appreciate your time thes air what we call our three colors. We definitely worked very hard to steward the skin to help protect. Let's get the largest organ of our body. We always look whether it's in the O R theater, the theater operating theater with you with operating room to help you prevent complications. Because together with you, we want to seek to help restore lives. So thank you so much for your time. Here's a brief look at the references. Thank you, Cindy, and thank you for attending today's Webinar. We hope you have gained new knowledge and understanding of early versus late initiation with back therapy. A special thank you to our speaker Cindy Miller Mikola Check for providing today's education and for you the attendees for taking time out of your busy schedules to attend, please visit Casey webinars dot com for additional archive Webinars, along with three m dot com resource is for beyond the hospital on behalf of three m. Thank you and have a nice day. The webinar is now concluded
